Feasibility of NIH consensus criteria for chronic graft-versus-host disease
Feasibility of NIH consensus criteria for chronic graft-versus-host disease
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DOI：
10.1038/leu.2008.276
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发表时间：
2009-01-01
期刊：
影响因子：
11.4
通讯作者：
Kim, C-C
中科院分区：
文献类型：
--
作者：
Cho, B-S;Min, C-K;Kim, C-C
为了评估美国国立卫生研究院(NIH)对慢性移植物抗宿主病(CGVHD)共识标准(NCC)的适用性，对211例异基因移植后100天以上发生GVHD的患者进行了NCC的重新分类。分型有：晚期急性移植物抗宿主病44例(21%)、重叠综合征综合征30%和经典型移植物抗宿主病103例(49%)。用修订的西雅图标准(RSC)和NIH全球评分(NGS)对167例典型cGVHD和重叠综合征患者进行分级。轻度23例(14%)，中度81例(48%)，重度63例(38%)。经过中位46个月(5-71个月)的随访，不同亚型NCC患者的4年移植物抗宿主病(GVHD)特异性生存期无显著差异。然而，在晚期急性移植物抗宿主病患者中，急性移植物抗宿主病的发病模式(晚期、持续性或复发性)与移植物抗宿主病特异性存活率显著不同。在重叠综合征和经典cGVHD患者中，多因素分析显示，尽管有更详细的分组，但NGS和RSC对预测免疫抑制治疗的存活和停止是有用的。我们的研究表明NCC是适用的。NIH类型和NGS的临床影响应通过前瞻性研究来验证。
To assess the applicability of the National Institutes of Health (NIH) consensus criteria (NCC) for chronic graft-versus-host disease (cGVHD), 211 patients who developed GVHD more than 100 days after allogeneic transplantation were reclassified using NCC. Classifications were: late acute GVHD (44 patients, 21%), overlap syndrome (64 patients, 30%) and classic cGVHD (103 patients, 49%). Classic cGVHD and overlap syndrome patients (n = 167) were graded using both the revised Seattle criteria (RSC) and NIH global scoring (NGS). Twenty-three patients (14%) had mild, 81 (48%) had moderate and 63 (38%) had severe cGVHD. After a median follow-up of 46 months (range 5-71 months), the 4- year GVHD-specific survival was not significantly different among the different subtypes of NCC. Among patients with late acute GVHD, however, the pattern of acute GVHD onset (late, persistent or recurrent) was significantly different with respect to GVHD-specific survival. Among patients with overlap syndrome and classic cGVHD, multivariate analysis showed that NGS as well as RSC were useful in predicting survival and discontinuation of immunosuppressive therapy despite of more detailed grouping. Our study indicates that NCC is applicable. The clinical impact of NIH types and NGS should be verified through prospective studies.