Classification systems for chronic graft-versus-host disease

Abstract

Chronic graft versus host disease (GVHD) is a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation. Clinically, chronic GVHD is a pleiotropic, multiorgan syndrome involving tissue inflammation and fibrosis that often results in permanent organ dysfunction. Chronic GVHD is fundamentally caused by replacement of the host’s immune system with donor cells, although the heterogeneity of clinical manifestations suggests that patient, donor, and transplant factors modulate the phenotype. The diagnosis of chronic GVHD and determination of treatment response largely rely on clinical examination and patient interview. The 2005 and 2014 National Institutes of Health Consensus Development Projects on Criteria for Clinical Trials in Chronic GVHD standardized the terminology around chronic GVHD classification systems to ensure that a common language and procedures are being used in clinical research. This review provides a summary of these recommendations and illustrates how they are being used in clinical research and the potential for their use in clinical care.

An endpoint associated with clinical benefit after initial treatment of chronic graft-versus-host disease

“…Many patients have irreversible impairment caused by skin and connective tissue sclerosis and damage to lacrimal and salivary glands, which greatly compromise quality of life. [5][6][7] Development of more effective treatments for chronic GVHD represents an urgent unmet clinical need.…”

Outcome of treosulfan‐based reduced‐toxicity conditioning regimens for HSCT in high‐risk patients with primary immune deficiencies

“…Treosulfan was combined with either Flu (150 mg/ mucositis, and other toxicities) were graded according to standard criteria indicated in references. [13][14][15][16] 3 | RE SULTS…”

Characteristics of graft‐versus‐host disease occurring after alemtuzumab‐containing allogeneic stem cell transplants: incidence, organ involvement, risk factors and survival

“…Recent advances have been made in the classification of GVHD which introduced the new entity of delayed, recurrent or late acute GVHD and further refined the previous entity of chronic GVHD (Filipovich et al , ). This added complexity not only enhances the scoring of GVHD in individual patients but also allows for more objective response assessment to treatments (Lee, ). The refined GVHD classification also has great utility in studying the detailed patterns of GVHD following HSCT regimens including the routing of patients from one form of GVHD to another.…”