TY - JOUR
T1 - Benefits and challenges with diagnosing chronic and late acute GVHD in children using the NIH consensus criteria
AU - Cuvelier, Geoffrey D.E.
AU - Nemecek, Eneida R.
AU - Wahlstrom, Justin T.
AU - Kitko, Carrie L.
AU - Lewis, Victor A.
AU - Schechter, Tal
AU - Jacobsohn, David A.
AU - Harris, Andrew C.
AU - Pulsipher, Michael A.
AU - Bittencourt, Henrique
AU - Choi, Sung Won
AU - Caywood, Emi H.
AU - Kasow, Kimberly A.
AU - Bhatia, Monica
AU - Oshrine, Benjamin R.
AU - Flower, Allyson
AU - Chaudhury, Sonali
AU - Coulter, Donald
AU - Chewning, Joseph H.
AU - Joyce, Michael
AU - Savaşan, Süreyya
AU - Pawlowska, Anna B.
AU - Megason, Gail C.
AU - Mitchell, David
AU - Cheerva, Alexandra C.
AU - Lawitschka, Anita
AU - West, Lori J.
AU - Pan, Bo
AU - Al Hamarneh, Yazid N.
AU - Halevy, Anat
AU - Schultz, Kirk R.
N1 - Funding Information:
This work was supported by the Canadian Institutes of Health Research (grant 255075). Pediatric Blood and Marrow Transplant Consortium efforts in this study were supported in part by a National Institutes of Health, National Heart, Lung, and Blood Institute grant U01HL069254 and by a grant from the Johnny Christopher Fund/St. Baldrick's Foundation.
Publisher Copyright:
© 2019 by The American Society of Hematology.
PY - 2019/7/18
Y1 - 2019/7/18
N2 - Chronic graft-versus-host disease (cGVHD) and late acute graft-versus-host disease (L-aGVHD) are understudied complications of allogeneic hematopoietic stem cell transplantation in children. The National Institutes of Health Consensus Criteria (NIH-CC) were designed to improve the diagnostic accuracy of cGVHD and to better classify graft-versushost disease (GVHD) syndromes but have not been validated in patients <18 years of age. The objectives of this prospective multi-institution study were to determine: (1) whether the NIH-CC could be used to diagnose pediatric cGVHD and whether the criteria operationalize well in a multi-institution study; (2) the frequency of cGVHD and L-aGVHD in children using theNIH-CC; and (3) the clinical features and risk factors for cGVHDand L-aGVHD using the NIH-CC. Twenty-seven transplant centers enrolled 302 patients <18 years of age before conditioning and prospectively followed them for 1 year posttransplant for development of cGVHD. Centers justified their cGVHD diagnosis according to the NIHCC using central review and a study adjudication committee. A total of 28.2% of reported cGVHD cases was reclassified, usually as L-aGVHD, following study committee review. Similar incidence of cGVHD and L-aGVHD was found (21% and 24.7%, respectively). The most common organs involved with diagnostic or distinctive manifestations of cGVHD in children include the mouth, skin, eyes, and lungs. Importantly, the 2014 NIHCC for bronchiolitis obliterans syndrome perform poorly in children. Past acute GVHD and peripheral blood grafts are major risk factors for cGVHD and L-aGVHD, with recipients ≥12 years of age being at risk for cGVHD. Applying theNIH-CC in pediatrics is feasible and reliable; however, further refinement of the criteria specifically for children is needed.
AB - Chronic graft-versus-host disease (cGVHD) and late acute graft-versus-host disease (L-aGVHD) are understudied complications of allogeneic hematopoietic stem cell transplantation in children. The National Institutes of Health Consensus Criteria (NIH-CC) were designed to improve the diagnostic accuracy of cGVHD and to better classify graft-versushost disease (GVHD) syndromes but have not been validated in patients <18 years of age. The objectives of this prospective multi-institution study were to determine: (1) whether the NIH-CC could be used to diagnose pediatric cGVHD and whether the criteria operationalize well in a multi-institution study; (2) the frequency of cGVHD and L-aGVHD in children using theNIH-CC; and (3) the clinical features and risk factors for cGVHDand L-aGVHD using the NIH-CC. Twenty-seven transplant centers enrolled 302 patients <18 years of age before conditioning and prospectively followed them for 1 year posttransplant for development of cGVHD. Centers justified their cGVHD diagnosis according to the NIHCC using central review and a study adjudication committee. A total of 28.2% of reported cGVHD cases was reclassified, usually as L-aGVHD, following study committee review. Similar incidence of cGVHD and L-aGVHD was found (21% and 24.7%, respectively). The most common organs involved with diagnostic or distinctive manifestations of cGVHD in children include the mouth, skin, eyes, and lungs. Importantly, the 2014 NIHCC for bronchiolitis obliterans syndrome perform poorly in children. Past acute GVHD and peripheral blood grafts are major risk factors for cGVHD and L-aGVHD, with recipients ≥12 years of age being at risk for cGVHD. Applying theNIH-CC in pediatrics is feasible and reliable; however, further refinement of the criteria specifically for children is needed.
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U2 - 10.1182/blood.2019000216
DO - 10.1182/blood.2019000216
M3 - Article
C2 - 31043425
AN - SCOPUS:85070114726
SN - 0006-4971
VL - 134
SP - 304
EP - 316
JO - Blood
JF - Blood
IS - 3
ER -