Severity of chronic graft-versus-host disease: association with treatment-related mortality and relapse

Abstract

Chronic graft-versus-host disease (cGVHD) is the leading cause of late treatmentrelated deaths among recipients of allogeneic bone marrow and blood transplants. However, cGVHD is also associated with fewer relapses. We sought to determine whether severity of cGVHD predicts the magnitude of these effects. One impediment to such an analysis is the current limited/extensive grading system for cGVHD because this classification was designed to identify patients likely to benefit from systemic immune suppression and does not capture the severity of multiorgan involvement. We, therefore, first developed a grading system predictive for survival by using data from 1827 HLAmatched sibling allotransplant recipients reported to the International Bone Marrow Transplant Registry (IBMTR). We found Karnofsky performance score, diarrhea, weight loss, and cutaneous and oral involvement to be independent prognostic variables, from which we generated a grading scheme. We tested this scheme, the limited/extensive classification sys-

Graft‐versus‐host disease (GVHD)‐specific survival and duration of systemic immunosuppressive treatment in patients who developed chronic GVHD following allogeneic haematopoietic cell transplantation

“…Progressive presentation and thrombocytopenia were important risk factors for death in several studies (Sullivan et al, 1988a;Wingard et al, 1989;Akpek et al, 2001), but not in other studies (Lee et al, 2002), including this study. No consensus has been reached regarding prognostic factors for survival in patients with chronic GVHD.…”

“…leukaemia relapses were lower in patients with chronic GVHD, regardless of its severity, compared with patients without chronic GVHD. Treatment-related mortality, however, was higher in patients with more severe GVHD (Lee et al, 2002). Accordingly, it is essential to stratify patients with chronic GVHD into different risk groups for GVHDrelated mortality.…”

Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD

“…This figure reflects the high morbidity and mortality rate in patients with steroid-refractory cGVHD. 16 In addition, the ECP facility is an out-patient unit, so patients had to be well enough to attend treatment. Another limitation is that only a minority of patients who completed 6 months of treatment had visceral localisation of GVHD.…”

Optimal management of chronic graft‐versus‐host disease in children

“…a patient with severe, but localized sclerosis) using these criteria, which were never validated. Recent studies have tried to define a higher-risk subset of patients, identifying criteria at diagnosis of chronic GVHD which are associated with poor long-term outcome (Akpek et al, 2001b(Akpek et al, , 2003Lee et al, 2002). The presence of some of these criteria (thrombocytopenia, extensive skin involvement, progressive onset, weight loss, diarrhoea, low Karnofsky performance score) in a patient may prompt a physician to treat more aggressively at the diagnosis of chronic GVHD.…”