Filipovich Alexandra H, Weisdorf Daniel, Pavletic Steven, Socie Gerard, Wingard John R, Lee Stephanie J, Martin Paul, Chien Jason, Przepiorka Donna, Couriel Daniel, Cowen Edward W, Dinndorf Patricia, Farrell Ann, Hartzman Robert, Henslee-Downey Jean, Jacobsohn David, McDonald George, Mittleman Barbara, Rizzo J Douglas, Robinson Michael, Schubert Mark, Schultz Kirk, Shulman Howard, Turner Maria, Vogelsang Georgia, Flowers Mary E D
Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229, USA.
Biol Blood Marrow Transplant. 2005 Dec;11(12):945-56. doi: 10.1016/j.bbmt.2005.09.004.
This consensus document is intended to serve 3 functions. First, it standardizes the criteria for diagnosis of chronic graft-versus-host disease (GVHD). Second, it proposes a new clinical scoring system (0-3) that describes the extent and severity of chronic GVHD for each organ or site at any given time, taking functional impact into account. Third, it proposes new guidelines for global assessment of chronic GVHD severity that are based on the number of organs or sites involved and the degree of involvement in affected organs (mild, moderate, or severe). Diagnosis of chronic GVHD requires the presence of at least 1 diagnostic clinical sign of chronic GVHD (e.g., poikiloderma or esophageal web) or the presence of at least 1 distinctive manifestation (e.g., keratoconjunctivitis sicca) confirmed by pertinent biopsy or other relevant tests (e.g., Schirmer test) in the same or another organ. Furthermore, other possible diagnoses for clinical symptoms must be excluded. No time limit is set for the diagnosis of chronic GVHD. The Working Group recognized 2 main categories of GVHD, each with 2 subcategories. The acute GVHD category is defined in the absence of diagnostic or distinctive features of chronic GVHD and includes (1) classic acute GVHD occurring within 100 days after transplantation and (2) persistent, recurrent, or late acute GVHD (features of acute GVHD occurring beyond 100 days, often during withdrawal of immune suppression). The broad category of chronic GVHD includes (1) classic chronic GVHD (without features or characteristics of acute GVHD) and (2) an overlap syndrome in which diagnostic or distinctive features of chronic GVHD and acute GVHD appear together. It is currently recommended that systemic therapy be considered for patients who meet criteria for chronic GVHD of moderate to severe global severity.
本共识文件旨在发挥三项作用。其一，规范慢性移植物抗宿主病（GVHD）的诊断标准。其二，提出一种新的临床评分系统（0 - 3分），该系统可描述在任何给定时间慢性GVHD累及每个器官或部位的范围和严重程度，并将功能影响考虑在内。其三，基于受累器官或部位的数量以及受累器官的累及程度（轻度、中度或重度），提出慢性GVHD严重程度全球评估的新指南。慢性GVHD的诊断需要至少存在1项慢性GVHD的诊断性临床体征（如皮肤异色症或食管蹼），或在同一或另一器官中经相关活检或其他相关检查（如泪液分泌试验）证实存在至少1项特征性表现（如干眼症）。此外，必须排除临床症状的其他可能诊断。慢性GVHD的诊断没有时间限制。工作组确认了GVHD的2个主要类别，每个类别又分为2个子类别。急性GVHD类别定义为不存在慢性GVHD的诊断性或特征性表现，包括（1）移植后100天内发生的典型急性GVHD，以及（2）持续性、复发性或晚期急性GVHD（急性GVHD特征出现在100天后，通常在免疫抑制撤减期间）。慢性GVHD的广义类别包括（1）典型慢性GVHD（无急性GVHD的特征或特点），以及（2）慢性GVHD和急性GVHD的诊断性或特征性表现同时出现的重叠综合征。目前建议，对于全球严重程度为中度至重度的慢性GVHD患者，应考虑进行全身治疗。
