Histopathologic Diagnosis of Chronic Graft-versus-Host Disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. Pathology Working Group Report

Abstract

This consensus document provides an update for pathologists and clinicians about the interpretation of biopsy results and use of this information in the management of hematopoietic cell transplantation patients. Optimal sampling and tissue preparation are discussed. Minimal criteria for the diagnosis of graft-versus-host disease (GVHD) are proposed, together with specific requirements for the diagnosis of chronic GVHD. Four final diagnostic categories (no GVHD, possible GVHD, consistent with GVHD, and definite GVHD) reflect the integration of histopathology with clinical, laboratory, and radiographic information. Finally, the Working Group developed a set of worksheets to facilitate communication of clinical information to the interpreting pathologist and to aid in clinicopathologic correlation studies. Forms are available at . The recommendations of the Working Group represent a consensus opinion supplemented by evaluation of available peer-reviewed literature. Consensus recommendations and suggested data-capture forms should be validated in prospective clinicopathologic studies.

The impact of morphological and immunohistological changes in minor salivary glands on the health of the oral cavity in HSCT patients

“…In fact, no significant differences were found in the degree of ductal dilation, comparing patients who developed cGVHD and those who did not. On the other hand, when ductal dilation, fibrosis and acinar degeneration were assessed together, as recommended by Shulman et al, 15 significant differences were found between cGVHD and noncGVHD patient samples. This reiterates that the tissue destruction caused by T-cell infiltrates is more important than the simple presence of ductal dilation.…”

“…clinical trials in cGVHD was issued, defining the most important diagnostic criteria for cGVHD. The recommendations of this group were published by Shulman et al 15 in 2006. With the aim of testing the value of the described features in predicting cGVHD severity and the OS of patients, we assessed all the criteria reported by Horn and Shulman (Table 2) on the MSG specimens of the three groups of individuals.…”

“…All specimens were assessed for histological cGVHD features according to: 1. the NIH consensus pathology working group (Table 2) 15 and 2. Horn et al 18 grading systems (Table 2).…”

“…[7][8][9] The typical histological findings of cGVHD in salivary glands are periductal and diffuse lobular lymphocyte infiltrate (CD8 þ over CD4 þ ), atrophy or destruction of acini, and fibrosis. 5,[10][11][12][13][14][15] Despite the advent of new therapies and management of cGVHD, minimal changes in this scenario have been observed, mainly due to an incomplete understanding of the pathogenesis of this disorder. 1,16 Knowing the most important histological findings for the diagnosis of minor salivary gland (MSG) cGVHD and its possible influence on overall patient health and understanding the mononuclear subset participation in salivary glands after HSCT can contribute to better management of those patients.…”

Pre-transplantation risk factors to develop sclerotic chronic GvHD after allogeneic HSCT: A multicenter retrospective study from the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC)

“…When sclerotic cGvHD is severe, contractures, severe wasting and chest wall restriction can occur. 1,2 Although sclerotic cGvHD is not an acute life-threatening manifestation, severe sclerotic cGvHD may lead to significant functional disability and morbidity. 3 This form of cGvHD has a negative impact on the quality of life (QoL) for patients.…”