Reproducibility in retrospective grading of acute graft-versus-host disease after allogeneic marrow transplantation
Reproducibility in retrospective grading of acute graft-versus-host disease after allogeneic marrow transplantation
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DOI：
10.1038/sj.bmt.1701083
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发表时间：
1998-02-01
影响因子：
4.8
通讯作者：
Appelbaum, F
中科院分区：
文献类型：
--
作者：
Martin, P;Nash, R;Appelbaum, F
本研究采用西雅图小组建立的标准，对100例骨髓移植患者进行回顾性评估，评估急性GVHD严重程度的可重复性。只有40%的病例中，所有三名评审员均指定了相同的GVHD等级，只有68-71%的病例中，所有三名评审员均指定了相同的等级，即0-I与II-IV_或0-II与III-IV类别，尽管任何两名评审员之间的分歧率很高，但在93%的病例中，至少有两名评审员指定了相同的GVHD总体等级，这些结果表明，目前由一个单一的审查者评估GVHD严重程度的标准对于严格的临床研究来说是不够可靠的。我们已经开发并测试了简化的标准，该标准总结了GVHD的临床过程，如疾病进展和GVHD的量所反映的。我们的研究结果表明，修订后的标准可能比原标准产生更可重复的回顾性分级，尽管原标准和修订后的标准可能对个体患者产生不同的结果，但两个系统的总体分级分布相似，建议的修订标准可以在不影响原有标准所定等级的连续性和一致性的情况下实施。
We have undertaken a formal study to evaluate the reproducibility of retrospective assessments for grading the severity of acute GVHD, Using criteria previously established by the Seattle group, three reviewers independently assigned GVHD severity grades for a set of 100 marrow transplant patients, Significant differences were found in the distribution of GVHD grades assigned by one of the reviewers as compared to the other two reviewers. In only 40% of cases did all three reviewers assign the same GVHD grade, and in only 68-71% of cases did all three reviewers assign the same grade within 0-I vs II-IV_or 0-II vs III-IV categories, Despite the high rate of disagreement between any two reviewers, at least two reviewers assigned the same overall GVHD grade in 93% of cases, These results suggest that current criteria for assessing the severity of GVHD by a single reviewer are not sufficiently reliable for rigorous clinical studies, As an alternative to the original criteria, we have developed and tested simplified criteria that summarize the clinical course of GVHD as reflected by the progression of disease and the amount of immunosuppressive treatment used to control the disease, Our results suggest that the revised criteria might yield more reproducible retrospective grading than the original criteria, Although the original criteria and the revised criteria might produce different results for individual patients, the overall distributions of grades with the two systems were similar, The proposed revised criteria could be implemented without disrupting the continuity and consistency with previous grading assigned by the original criteria.