National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report.
This consensus document is intended to serve 3 functions. First, it standardizes the criteria for diagnosis of chronic graft-versus-host disease (GVHD). Second, it proposes a new clinical scoring system (0-3) that describes the extent and severity of chronic GVHD for each organ or site at any given time, taking functional impact into account. Third, it proposes new guidelines for global assessment of chronic GVHD severity that are based on the number of organs or sites involved and the degree of involvement in affected organs (mild, moderate, or severe). Diagnosis of chronic GVHD requires the presence of at least 1 diagnostic clinical sign of chronic GVHD (e.g., poikiloderma or esophageal web) or the presence of at least 1 distinctive manifestation (e.g., keratoconjunctivitis sicca) confirmed by pertinent biopsy or other relevant tests (e.g., Schirmer test) in the same or another organ. Furthermore, other possible diagnoses for clinical symptoms must be excluded. No time limit is set for the diagnosis of chronic GVHD. The Working Group recognized 2 main categories of GVHD, each with 2 subcategories. The acute GVHD category is defined in the absence of diagnostic or distinctive features of chronic GVHD and includes (1) classic acute GVHD occurring within 100 days after transplantation and (2) persistent, recurrent, or late acute GVHD (features of acute GVHD occurring beyond 100 days, often during withdrawal of immune suppression). The broad category of chronic GVHD includes (1) classic chronic GVHD (without features or characteristics of acute GVHD) and (2) an overlap syndrome in which diagnostic or distinctive features of chronic GVHD and acute GVHD appear together. It is currently recommended that systemic therapy be considered for patients who meet criteria for chronic GVHD of moderate to severe global severity.
Filipovich
Alexandra H
AH
Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229, USA. lisa.filipovich@cchmc.org
Weisdorf
Daniel
D
Pavletic
Steven
S
Socie
Gerard
G
Wingard
John R
JR
Lee
Stephanie J
SJ
Martin
Paul
P
Chien
Jason
J
Przepiorka
Donna
D
Couriel
Daniel
D
Cowen
Edward W
EW
Dinndorf
Patricia
P
Farrell
Ann
A
Hartzman
Robert
R
Henslee-Downey
Jean
J
Jacobsohn
David
D
McDonald
George
G
Mittleman
Barbara
B
Rizzo
J Douglas
JD
Robinson
Michael
M
Schubert
Mark
M
Schultz
Kirk
K
Shulman
Howard
H
Turner
Maria
M
Vogelsang
Georgia
G
Flowers
Mary E D
ME
D002908:Chronic Disease; D002986:Clinical Trials as Topic; D032921:Consensus; D015975:Consensus Development Conferences, NIH as Topic; D003937:Diagnosis, Differential; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D009316:National Institutes of Health (U.S.); D014481:United States