Oral chronic graft-vs.-host disease characterization using the NIH scale.
Chronic graft-vs.-host disease (cGVHD) is a complication of allogeneic hematopoietic stem cell transplantation (alloHSCT). Oral cGVHD is manifested by mucosal, salivary, and/or sclerotic changes that have been linked to pain and poor quality of life. Our aim was to describe the demographic, clinical, and laboratory markers of oral cGVHD in alloHSCT patients (N = 187) enrolled in a cGVHD cross-sectional study at the NIH (#NCT00331968). We propose a meaningful and reproducible measure of disease defined by a cut-off point reflecting clinical minimally detectable change (0-2 = no oral cGVHD, 3-15 = oral cGVHD) on the 15-point NIH cGVHD clinician assessment scale. Forty-four patients had oral cGVHD. Oral cGVHD was associated with a quiescent or de novo type of cGVHD onset (p = 0.05), higher cGVHD severity (p = 0.033), lower albumin (p = 0.0008), higher total complement (p = 0.012), greater bother from foods or oral ulcers and greater mouth pain, and sensitivity (p < 0.0001). Multivariable logistic regression modeling with albumin, mouth pain, and total complement was 74.3% predictive of oral cGVHD and 80.2% predictive of non-oral cGVHD. We propose the use of >2 points on the NIH scale as a reproducible definition of clinically significant oral cGVHD, which may be useful in clinical settings or as eligibility criterion or as an endpoint in clinical trials.
Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, 10 Center Drive, Bethesda, MD 20892, USA. helen.fassil@tufts.edu
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H
Fassil
C W
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Bassim
J
J
Mays
D
D
Edwards
K
K
Baird
S M
SM
Steinberg
K M
KM
Williams
E W
EW
Cowen
S A
SA
Mitchell
F T
FT
Hakim
T
T
Taylor
D
D
Avila
D
D
Zhang
L
L
Grkovic
M
M
Datiles
R E
RE
Gress
S Z
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Pavletic
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D003165:Complement System Proteins / Q000032:analysis; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004890:Erythema / Q000175:diagnosis; D005500:Follow-Up Studies; D005502:Food; D005544:Forecasting; D006086:Graft vs Host Disease / Q000145:classification / Q000175:diagnosis*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017512:Lichenoid Eruptions / Q000175:diagnosis; D008875:Middle Aged; D009059:Mouth Diseases / Q000145:classification / Q000175:diagnosis*; D009078:Mucocele / Q000175:diagnosis; D019226:Oral Ulcer / Q000175:diagnosis; D010146:Pain / Q000175:diagnosis; D012709:Serum Albumin / Q000032:analysis; D013280:Stomatitis / Q000175:diagnosis; D014184:Transplantation, Homologous; D055815:Young Adult
D015415:Biomarkers; D007166:Immunosuppressive Agents; D012709:Serum Albumin; D003165:Complement System Proteins