Evaluation of NIH consensus criteria for classification of late acute and chronic GVHD
Evaluation of NIH consensus criteria for classification of late acute and chronic GVHD
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DOI：
10.1182/blood-2009-03-208983
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发表时间：
2009-07-16
期刊：
影响因子：
20.3
通讯作者：
Flowers, Mary E. D.
中科院分区：
文献类型：
--
作者：
Vigorito, Afonso C.;Campregher, Paulo V.;Flowers, Mary E. D.
历史上，造血细胞移植（HCT）后超过100天的移植物抗宿主病（GVHD）被称为慢性GVHD，即使其临床表现与急性GVHD无法区分。2005年，美国国立卫生研究院（NIH）发起了一次共识会议，提出了用于临床试验的慢性GVHD诊断和分类的新标准。根据共识的标准，临床试验中区分慢性GVHD和晚期急性GVHD应以临床表现而不是移植后的时间，包括持续性、复发性或晚发性急性GVHD。我们根据NIH慢性GVHD标准的存在与否，对1994年至2000年间740例同种异体HCT后诊断为慢性GVHD的患者进行了回顾性研究，评估了主要结果。是否存在慢性GVHD的NIH标准与生存率、非复发死亡率或复发恶性肿瘤的风险或全身治疗的持续时间没有统计学上的显著关联。在NIH慢性GVHD患者中，先前的晚期急性GVHD与非复发死亡率和延长治疗的风险增加有关。我们的结果支持共识建议，通过适当的分层，临床试验可以包括晚期急性GVHD患者以及NIH慢性GVHD患者。(血。2009;114:702 - 708)
Historically, graft-versus-host disease (GVHD) beyond 100 days after hematopoietic cell transplantation (HCT) was called chronic GVHD, even if the clinical manifestations were indistinguishable from acute GVHD. In 2005, the National Institutes of Health (NIH) sponsored a consensus conference that proposed new criteria for diagnosis and classification of chronic GVHD for clinical trials. According to the consensus criteria, clinical manifestations rather than time after transplantation should be used in clinical trials to distinguish chronic GVHD from late acute GVHD, which includes persistent, recurrent, or late-onset acute GVHD. We evaluated major outcomes according to the presence or absence of NIH criteria for chronic GVHD in a retrospective study of 740 patients diagnosed with historically defined chronic GVHD after allogeneic HCT between 1994 and 2000. The presence or absence of NIH criteria for chronic GVHD showed no statistically significant association with survival, risks of nonrelapse mortality or recurrent malignancy, or duration of systemic treatment. Antecedent late acute GVHD was associated with an increased risk of nonrelapse mortality and prolonged treatment among patients with NIH chronic GVHD. Our results support the consensus recommendation that, with appropriate stratification, clinical trials can include patients with late acute GVHD as well as those with NIH chronic GVHD. (Blood. 2009;114:702-708)