Incidence and outcome of chronic graft-versus-host disease using National Institutes of Health consensus criteria.
Chronic graft-versus-host disease (cGVHD), a common complication after stem cell transplant (SCT), has an impact on morbidity and survival. Previous classification of cGVHD has not been reproducible or prognostic for nonrelapse mortality (NRM). Recently the National Institutes of Health (NIH) consensus criteria were proposed, but the ability of this classification to predict outcome of various subtypes of cGVHD is unknown. Patients (N = 110) undergoing an SCT for a hematologic malignancy and surviving until day 100 posttransplant from 2001 to 2003 were studied. The overall survival (OS) using a landmark analysis at day 100 was 44% versus 66% (no GVHD vs. GVHD, P = .026). The OS of patients with various types of GVHD as proposed by the NIH criteria were significantly different (P < .0001). In a univariate analyses, this was more apparent when patients with any acute features of GVHD were compared to classic cGVHD (3-year OS 46% vs. 68%, P = .033). The 3-year NRM for the entire cohort was 21%, and was not affected by presence or absence of GVHD or subtypes of GVHD. In a multivariable analysis, extensive cGVHD (hazard ratio [HR] 0.35, P = .015) and having any acute feature of GVHD after day 100 (HR 3.36, P = .0144) were significant independent predictors of survival. The OS with different NIH subtypes of GVHD after day 100 from SCT varies, and is superior for patients with classic cGVHD.
Jagasia
Madan
M
Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. madan.jagasia@vanderbilt.edu
Giglia
Jennifer
J
Chinratanalab
Wichai
W
Dixon
Sheri
S
Chen
Heidi
H
Frangoul
Haydar
H
Engelhardt
Brian
B
Goodman
Stacey
S
Greer
John
J
Kassim
Adetola
A
Morgan
David
D
Ruffner
Katherine
K
Schuening
Friedrich
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000145:classification* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D017410:Practice Guidelines as Topic; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013714:Tennessee / Q000453:epidemiology; D014481:United States