Abstract
Abstract 1946
A new grading system for graft-versus-host disease (GVHD) severity was established by the National Institute of Health (NIH)-consensus criteria (NCC) which was introduced since 2007. However, prognostic implications of the NCC grading system on GVHD-specific survival (GSS) are still on debate.
A total of 425 consecutive patients who survived beyond 100 days following allogeneic hematopoietic stem cell transplantation (HSCT) at the Princess Margaret Hospital from Jan 1996 to Oct 2007 were reviewed retrospectively and reclassified using the NCC. The GVHD-specific survival was compared according to the severity at onset or at peak of cGVHD by the NCC.
Out of 425 patients, 346 patients (81.4%) were diagnosed to have chronic GVHD (cGVHD) by the Revised Seattle criteria (RSC). Among them, 317 patients were reclassified to have classic cGVHD (n=144, 41.6%) and overlap syndrome (n=173, 50.0%) by the NCC. Twenty nine patients (8.4%) were reclassified as late-onset/recurrent acute GVHD. Out of 317 patients diagnosed to have a classic chronic GVHD and overlap syndrome, the severity scores at the onset of cGVHD were as follows: mild (n=137, 43.2%), moderate (n=134, 42.3%) and severe (n=46, 14.5%), while more moderate and severe cGVHD was noted when severity score was assessed at the peak time of cGVHD as mild (41, 12.9%), moderate (n=176, 55.5%) and severe (n=100, 31.6%). With median follow-up duration of 34 months (range 4–93 months), 5 yrs GSS rate was significantly worse in the group with severe grade of cGVHD at onset and at peak: 50.9±7.8% in severe vs. 89.7±3.2% in moderate vs. 93.5±2.4% in mild (at onset, p<0.001) and 69.1±5.2% in severe vs. 93.2±2.1% in moderate vs. 97.3±2.7% in mild (at peak, p<0.001). No differences in GSS were noted between moderate and mild grades of cGVHD at onset and at peak. Multivariate analysis confirmed severe grade of cGVHD at onset (HR 5.18, 95% CI=1.97–13.6) and at peak (HR 3.79, 95% CI=1.79–8.07) by NCC is associated with poor survival.
The present study has successfully validated the grading system of NCC. The NCC could predict long-term outcome in the patients with cGVHD and could potentially be used to develop risk-stratified approaches to treatment based on NCC grading. The group with severe grade cGVHD presented inferior long-term outcomes than those with mild/moderate grade cGVHD.
A. GSS according to the Revised Seattle Criteria, B. GSS according to the NIH Global score at onset, C. GSS according to the NIH Global score at peak
No relevant conflicts of interest to declare.
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