Comparison of the 2014 NIH cGVHD consensus criteria, the 2019 ISHLT CLAD criteria, and the adapted criteria
| Criteria . | NIH criteria . | ISHLT CLAD criteria . | Adapted criteria . |
|---|---|---|---|
| Diagnosis | FEV1/VC < 0.7 or the 5th percentile predicted based on population-based reference; VC is either FVC or SVC, whichever is greater; FEV1 < 75% predicted with ≥ 10% decrease over less than 2 y, not corrected with albuterol | Persistent decline (> 3 mo, ≥ 20%) of FEV1 from the reference baseline; baseline is the mean of the best 2 post-transplant FEV1 measurements taken 3 wk apart | Abnormal pulmonary function after transplant (FEV1 < 80% predicted based on population-based reference), able to be classified into 1 of the 4 CLAD-PcGVHD subtypes, rule out other causes of pulmonary dysfunction |
| Phenotype | BOS: FEV1/VC < 0.7 or the 5th percentile predicted based on population-based reference; VC is either FVC or SVC, whichever is greater; evidence of air-trapping by expiratory CT or airway thickening or bronchiectasis by high-resolution CT, or air-trapping by PFT | BOS: obstruction (FEV1/FVC < 0.7), without restriction or CT opacity; RAS: restriction (TLC < 90% baseline) + CT opacity, FEV1/FVC ≥ 0.7; mixed: FEV1/FVC < 0.7, TLC < 90% baseline, with CT opacity; undefined: A. FEV1/FVC < 0.7, TLC < 90% baseline, NO CT opacity; B. FEV1/FVC < 0.7, TLC ≥ 90% baseline, WITH CT opacity | Obstruction: obstruction (FEV1/FVC < 0.7), without restrictive findings on PFT or CT; restriction: restriction (TLC < 90% predicted), with restrictive CT findings,* FEV1/FVC ≥ 0.7; mixed: FEV1/FVC < 0.7, TLC < 90% predicted, restrictive CT findings; undefined: A. FEV1/FVC < 0.7, TLC < 90% predicted, NO restrictive CT findings; B. FEV1/FVC < 0.7, TLC ≥ 90% predicted, WITH restrictive CT findings |
| Criteria . | NIH criteria . | ISHLT CLAD criteria . | Adapted criteria . |
|---|---|---|---|
| Diagnosis | FEV1/VC < 0.7 or the 5th percentile predicted based on population-based reference; VC is either FVC or SVC, whichever is greater; FEV1 < 75% predicted with ≥ 10% decrease over less than 2 y, not corrected with albuterol | Persistent decline (> 3 mo, ≥ 20%) of FEV1 from the reference baseline; baseline is the mean of the best 2 post-transplant FEV1 measurements taken 3 wk apart | Abnormal pulmonary function after transplant (FEV1 < 80% predicted based on population-based reference), able to be classified into 1 of the 4 CLAD-PcGVHD subtypes, rule out other causes of pulmonary dysfunction |
| Phenotype | BOS: FEV1/VC < 0.7 or the 5th percentile predicted based on population-based reference; VC is either FVC or SVC, whichever is greater; evidence of air-trapping by expiratory CT or airway thickening or bronchiectasis by high-resolution CT, or air-trapping by PFT | BOS: obstruction (FEV1/FVC < 0.7), without restriction or CT opacity; RAS: restriction (TLC < 90% baseline) + CT opacity, FEV1/FVC ≥ 0.7; mixed: FEV1/FVC < 0.7, TLC < 90% baseline, with CT opacity; undefined: A. FEV1/FVC < 0.7, TLC < 90% baseline, NO CT opacity; B. FEV1/FVC < 0.7, TLC ≥ 90% baseline, WITH CT opacity | Obstruction: obstruction (FEV1/FVC < 0.7), without restrictive findings on PFT or CT; restriction: restriction (TLC < 90% predicted), with restrictive CT findings,* FEV1/FVC ≥ 0.7; mixed: FEV1/FVC < 0.7, TLC < 90% predicted, restrictive CT findings; undefined: A. FEV1/FVC < 0.7, TLC < 90% predicted, NO restrictive CT findings; B. FEV1/FVC < 0.7, TLC ≥ 90% predicted, WITH restrictive CT findings |
RAS, restrictive allograft syndrome.
Restrictive CT scan findings include ground glass opacities, parenchymal consolidation, traction bronchiectasis, lobar volume loss, usual interstitial pneumonitis pattern, and pleural abnormalities.