title: The National Institutes of Health criteria for classification and scoring of chronic graft versus host disease: long-term follow-up of a single center series.
abstract: We assessed the retrospective applicability and prognostic value of the National Institutes of Health (NIH) classification of chronic graft versus host disease (cGVHD) in 159 consecutive patients after allogeneic hematopoietic stem cell transplant (HSCT). Seventy-four patients (46.5%) were affected by late-acute GVHD (n = 19; 25.7%), classic cGVHD (n = 44; 59.4%) and overlap syndrome (n = 11; 14.9%). Overall, patients with NIH-defined cGVHD (i.e. classic cGVHD and overlap syndrome) had better 10-year overall survival (OS) as compared to patients without GVHD (76.9% vs. 47.4%, p = 0.0002) or with late-acute GVHD (47.4%, p = 0.001). Relapse mortality (RM) was lower in patients with NIH-defined cGVHD than in patients without GVHD (14.5% vs. 38.7%, p = 0.001), but comparable to that of late-acute type (19.4%, p = 0.31). Non-relapse mortality (NRM) was lower in patients with NIH-defined cGVHD as compared to late-acute GVHD (10.0% vs. 41.1%, p = 0.0005), as well as patients without GVHD (22.2%, p = 0.045). At multivariate analysis, NIH-defined cGVHD remained independently predictive for lower RM, but not for NRM. Thus, the new NIH classification identifies two subtypes of GVHD (late-acute and chronic) with different long-term outcomes and impact on RM and NRM.
authors.affiliation: Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine, University of Verona , Verona , Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Tecchio
authors.forename: Federico
authors.initials: F
authors.lastname: Mosna
authors.forename: Angelo
authors.initials: A
authors.lastname: Andreini
authors.forename: Laura
authors.initials: L
authors.lastname: Paoli
authors.forename: Raimondo
authors.initials: R
authors.lastname: Di Bella
authors.forename: Donata
authors.initials: D
authors.lastname: de Sabata
authors.forename: Marco
authors.initials: M
authors.lastname: Sorio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pizzolo
authors.forename: Fabio
authors.initials: F
authors.lastname: Benedetti
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D055815:Young Adult