Yonsei Med J.  2011 Sep;52(5):779-786. 10.3349/ymj.2011.52.5.779.

Prognostic Implications of the NIH Consensus Criteria in Children with Chronic Graft-versus-Host Disease

• Lee JW
• Lee DH
• Jang PS
• Yi MS
• Chung NG
• Cho B
• Jeong DC
• Kim HK

• KMID: 1108071
• DOI: http://doi.org/10.3349/ymj.2011.52.5.779

Abstract

PURPOSE
In this study, we analyzed a cohort of children with chronic graft-versus-host disease (GvHD) according to the NIH consensus classification (NCC) in order to observe whether global assessment at diagnosis correlates with GvHD-specific endpoints. We then studied the clinical course of these patients, specifically with regards to episodes of GvHD exacerbation requiring treatment escalation.
MATERIALS AND METHODS
Recipients of either allogeneic bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) from January 2006 to August 2008 at the Department of Pediatrics, The Catholic University of Korea were evaluated for chronic GvHD, which was diagnosed according to the NCC. The course of chronic GvHD in these patients was then followed.
RESULTS
Of 59 evaluable patients, 23 developed chronic GvHD for a cumulative incidence of 39.3%. Upon multivariate analysis, previous acute GvHD (> or =grade II) had a significant impact on chronic GvHD incidence. With a median duration of systemic treatment for chronic GvHD of 501 days, no significant relationship was found between initial global severity of chronic GvHD and either duration of immunosuppressive treatment or final clinical response to treatment. Fifteen patients (65%) experienced at least one episode of chronic GvHD exacerbation during the period of follow-up, with a median of four exacerbations in the subgroup of patients who experienced such events. Lung GvHD resulted in the highest number of exacerbations per diagnosed patient, followed by oral GvHD.
CONCLUSION
Analysis of this small cohort indicates that global assessment as proposed by the NCC may have limited correlations with GvHD-specific endpoints, possibly due to the favorable response of children to treatment.

Keyword

Chronic GvHD; NIH consensus criteria; children

MeSH Terms

Adolescent
Bone Marrow Transplantation/adverse effects
Child
Child, Preschool
Chronic Disease
Cohort Studies
Consensus Development Conferences, NIH as Topic
Female
Graft vs Host Disease/classification/*diagnosis/drug therapy/etiology
Humans
Immunosuppressive Agents/administration & dosage
Infant
Male
National Institutes of Health (U.S.)
Peripheral Blood Stem Cell Transplantation/adverse effects
Prognosis
Republic of Korea
Risk Factors
United States

Figure

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  Fig. 1 (A) Probability of withdrawal of systemic IST. (B) Probability of withdrawal of systemic IST according to initial global severity of chronic GvHD. (C)Probability of withdrawal of systemic IST according to initial global severity of chronic GvHD (with inclusion of hepatic GvHD). GvHD, graft-versus-host disease.

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  Fig. 2 Chronic GvHD organ involvement throughout the follow-up period. GvHD, graft-versus-host disease.

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