title: Confounding factors affecting the National Institutes of Health (NIH) chronic Graft-Versus-Host Disease Organ-Specific Score and global severity.
abstract: The 2005 NIH chronic GVHD (cGVHD) organ severity is based on the assessment of current status regardless of whether abnormalities are due to GVHD. The score assignment does not require knowledge of past manifestations, attribution or whether cGVHD is still active. The aim of this study is to describe confounding factors affecting organ scores in patients with cGVHD. The study included 189 consecutive cGVHD patients evaluated at our center in 2013. Providers completed the NIH 0-3 organ-specific scoring evaluation with two questions added for each organ to identify abnormalities that were (i) not attributed to cGVHD or (ii) attributed to cGVHD plus other causes. Abnormalities attributed to causes other than GVHD were recorded. Eighty (14%) abnormalities were not attributed to cGVHD in at least one organ, and 41 (7%) abnormalities were attributed to cGVHD plus other causes in at least one organ. A total of 436 (78%) abnormalities were attributed only to cGVHD. Abnormalities not attributed to cGVHD were observed most frequently in the lung, gastrointestinal tract and skin. Most common abnormalities included pre-transplant condition, sequelae from GVHD, deconditioning, infections and medications. Our results support the 2014 NIH consensus recommendation to consider attribution when scoring organ abnormalities.
authors.affiliation: Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA.|Gazi University Faculty of Medicine Department of Hematology, Ankara, Turkey.
authors.forename: S Z
authors.initials: SZ
authors.lastname: Aki
authors.affiliation: Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Inamoto
authors.affiliation: Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA.|University of Washington, Division of Medical Oncology, Seattle, WA, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Carpenter
authors.affiliation: Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA.|University of Washington, Division of Medical Oncology, Seattle, WA, USA.
authors.forename: B E
authors.initials: BE
authors.lastname: Storer
authors.affiliation: Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA.|University of Washington, Division of Medical Oncology, Seattle, WA, USA.
authors.forename: B M
authors.initials: BM
authors.lastname: Sandmaier
authors.affiliation: Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA.|University of Washington, Division of Medical Oncology, Seattle, WA, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA.|University of Washington, Division of Medical Oncology, Seattle, WA, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Martin
authors.affiliation: Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA.|University of Washington, Division of Medical Oncology, Seattle, WA, USA.
authors.forename: M E D
authors.initials: ME
authors.lastname: Flowers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D012720:Severity of Illness Index; D012871:Skin Diseases / Q000209:etiology; D014481:United States; D055815:Young Adult