title: Validation of International Chronic Ocular Graft-Versus-Host Disease (GVHD) Group Diagnostic Criteria as a Chronic Ocular GVHD-Specific Metric.
abstract: OBJECTIVE
  To validate the International Chronic Ocular GVHD Consensus Group (ICCGVHD) diagnostic criteria for chronic ocular chronic graft-versus-host disease (GVHD), by comparing results with comprehensive ophthalmic evaluation after allogeneic hematopoietic stem cell transplantation.
  
  
  METHODS
  A single-institution retrospective chart review was conducted on patients who underwent hematopoietic stem cell transplantation at Vanderbilt University Medical Center in Nashville, TN, from January 1, 2002, through April 17, 2014. A total of 344 patients were eligible for the study. Data collected include the Schirmer test score, corneal fluorescein staining, Ocular Surface Disease Index, conjunctival injection, and presence or absence of systemic GVHD. The diagnosis of chronic ocular GVHD in each participant and determination of the overall severity score were determined based on the newly proposed ICCGVHD diagnostic criteria and compared with the best clinical practice (BCP) score.
  
  
  RESULTS
  Chronic ocular GVHD was diagnosed in 141/344 (41%) participants, of these, 86 (61%) had complete charts. Based on the BCP score, 1.2% had none, 38.4% mild, 47.7% moderate, and 12.8% had severe chronic ocular GVHD. Based on the ICCGVHD, 34.8% had none, 59.3% mild/moderate, and 5.8% had severe chronic ocular GVHD. The clinical diagnostic stages of chronic ocular GVHD by BCP and ICCGVHD criteria had slight agreement (kappa statistic 0.187, with 95% confidence interval 0.049-0.321), with a higher correlation seen in those with severe chronic ocular GVHD.
  
  
  CONCLUSIONS
  The newly proposed ICCGVHD diagnostic criteria can be used reproducibly for the diagnosis and determination of severity of chronic ocular GVHD. However, larger prospective studies are needed to further validate it.
authors.affiliation: *Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, TN; †Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Boston, MA; ‡Department of Medicine, Division of Hematology/Oncology, Vanderbilt University School of Medicine, Nashville, TN; and §Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Yuna
authors.initials: Y
authors.lastname: Rapoport
authors.forename: Thomas
authors.initials: T
authors.lastname: Freeman
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Koyama
authors.forename: Brian G
authors.initials: BG
authors.lastname: Engelhardt
authors.forename: Madan
authors.initials: M
authors.lastname: Jagasia
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.forename: Uyen
authors.initials: U
authors.lastname: Tran
authors.forename: Adetola A
authors.initials: AA
authors.lastname: Kassim
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D002908:Chronic Disease; D003229:Conjunctival Diseases / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D015352:Dry Eye Syndromes / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006086:Graft vs Host Disease / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D038801:International Classification of Diseases / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D015415:Biomarkers