Measurement of oral chronic GVHD: results from the Chronic GVHD Consortium
Measurement of oral chronic GVHD: results from the Chronic GVHD Consortium
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DOI：
10.1038/bmt.2012.285
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发表时间：
2013-08-01
影响因子：
4.8
通讯作者：
Cutler, C.
中科院分区：
文献类型：
--
作者：
Treister, N.;Chai, X.;Cutler, C.
口腔慢性GVHD（cGVHD）是alloSCT的严重并发症。测量口腔 cGVHD 活性和严重程度的量表和仪器尚未经过前瞻性验证。本研究的目的是描述口服 cGVHD 的特征并确定对变化最敏感的措施。纳入 cGVHD 联盟的口腔受累患者也被纳入其中。临床医生根据美国国立卫生研究院 (NIH) 标准对口腔变化进行评分，患者在每次就诊时完成症状和生活质量测量。两者都对变化进行了八分制评分。在 458 名参与者中，72% (n = 331) 在登记时有客观的口头参与。苔藓样变化是最常见的特征（n = 293；89%）。在可以评估口腔变化的就诊中，50% 的临床医生和 56% 的患者报告病情有所改善，两组均报告有 4-5% 的病情恶化（加权 kappa = 0.41）。多变量回归模型表明，最能预测临床医生和患者感知变化的测量变化是红斑和苔藓样变、NIH 严重程度和症状评分。口服 cGVHD 很常见，并与一系列体征和症状相关。红斑和苔藓样变化和症状的测量可以充分捕捉临床试验中口服 cGVHD 的活性，但需要前瞻性验证。
Oral chronic GVHD (cGVHD) is a serious complication of alloSCT. Scales and instruments to measure oral cGVHD activity and severity have not been prospectively validated. The objective of this study was to describe the characteristics of oral cGVHD and determine the measures most sensitive to change. Patients enrolled in the cGVHD Consortium with oral involvement were included. Clinicians scored oral changes according to the National Institutes of Health (NIH) criteria, and patients completed symptom and quality-of-life measures at each visit. Both rated change on an eight-point scale. Of the 458 participants, 72% (n = 331) had objective oral involvement at enrollment. Lichenoid change was the most common feature (n = 293; 89%). At visits where oral change could be assessed, 50% of clinicians and 56% of patients reported improvement, with worsening reported in 4-5% for both the groups (weighted kappa = 0.41). Multivariable regression modeling suggested that the measurement changes most predictive of perceived change by clinicians and patients were erythema and lichenoid, NIH severity and symptom scores. Oral cGVHD is common and associated with a range of signs and symptoms. Measurement of erythema and lichenoid changes and symptoms may adequately capture the activity of oral cGVHD in clinical trials but require prospective validation.