title: Prognostic implications of the NIH consensus criteria in children with chronic graft-versus-host disease.
abstract: OBJECTIVE
  In this study, we analyzed a cohort of children with chronic graft-versus-host disease (GvHD) according to the NIH consensus classification (NCC) in order to observe whether global assessment at diagnosis correlates with GvHD-specific endpoints. We then studied the clinical course of these patients, specifically with regards to episodes of GvHD exacerbation requiring treatment escalation.
  
  
  METHODS
  Recipients of either allogeneic bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) from January 2006 to August 2008 at the Department of Pediatrics, The Catholic University of Korea were evaluated for chronic GvHD, which was diagnosed according to the NCC. The course of chronic GvHD in these patients was then followed.
  
  
  RESULTS
  Of 59 evaluable patients, 23 developed chronic GvHD for a cumulative incidence of 39.3%. Upon multivariate analysis, previous acute GvHD (≥grade II) had a significant impact on chronic GvHD incidence. With a median duration of systemic treatment for chronic GvHD of 501 days, no significant relationship was found between initial global severity of chronic GvHD and either duration of immunosuppressive treatment or final clinical response to treatment. Fifteen patients (65%) experienced at least one episode of chronic GvHD exacerbation during the period of follow-up, with a median of four exacerbations in the subgroup of patients who experienced such events. Lung GvHD resulted in the highest number of exacerbations per diagnosed patient, followed by oral GvHD.
  
  
  CONCLUSIONS
  Analysis of this small cohort indicates that global assessment as proposed by the NCC may have limited correlations with GvHD-specific endpoints, possibly due to the favorable response of children to treatment.
authors.affiliation: Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Jae Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Dae-Hyoung
authors.initials: DH
authors.lastname: Lee
authors.forename: Pil-Sang
authors.initials: PS
authors.lastname: Jang
authors.forename: Mi-Sung
authors.initials: MS
authors.lastname: Yi
authors.forename: Nack-Gyun
authors.initials: NG
authors.lastname: Chung
authors.forename: Bin
authors.initials: B
authors.lastname: Cho
authors.forename: Dae-Chul
authors.initials: DC
authors.lastname: Jeong
authors.forename: Hack-Ki
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D015975:Consensus Development Conferences, NIH as Topic; D005260:Female; D006086:Graft vs Host Disease / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D008297:Male; D009316:National Institutes of Health (U.S.); D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D011379:Prognosis; D056910:Republic of Korea; D012307:Risk Factors; D014481:United States
chemical_list: D007166:Immunosuppressive Agents