Department of Hematology and Medical Oncology, Kyungpook National University Hospital, Daegu, Korea.
Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
Biol Blood Marrow Transplant. 2014 Apr;20(4):556-63. doi: 10.1016/j.bbmt.2014.01.010. Epub 2014 Jan 18.
A new severity grading system for graft-versus-host disease (GVHD) was established by the National Institutes of Health (NIH) consensus criteria (NCC). However, its prognostic value still needs to be validated. Four hundred twenty-five consecutive patients who survived beyond 100 days after allogeneic stem cell transplantation were reviewed and reclassified using NCC. GVHD-specific survival (GSS) and cumulative incidence of relapse were compared according to the NIH global score at the onset and peak of chronic GVHD (cGVHD). Of 346 patients with cGVHD diagnosed by the Revised Seattle Criteria, 317 patients were reclassified according to the NCC as classic cGVHD (n = 144) and overlap syndrome (n = 173). The NIH global scores at onset were mild (43.2%), moderate (42.3%), and severe (14.5%), whereas more moderate (55.5%) and severe (31.6%) cGVHD was observed at the peak of cGVHD. With a median follow-up duration of 34 months, the 5-year GSS was significantly worse for the severe group than the moderate/mild groups at onset and at peak: 50.9% ± 7.8% versus 89.7% ± 3.2% versus 93.5% ± 2.4% at onset (P < .001) and 69.1% ± 5.2% versus 93.2% ± 2.1% versus 97.3% ± 2.7% at peak (P < .001). Severe NIH global score at onset and peak were confirmed as a poor prognostic factor for GSS in multivariate analysis. The cumulative incidence of relapse did not differ among the severity groups at onset or peak. In conclusion, the new NIH global scoring system was shown to differentiate a high-risk group of patients (with severe grade cGVHD) in terms of long-term transplant outcomes.
一种新的移植物抗宿主病（GVHD）严重程度分级系统由美国国立卫生研究院（NIH）共识标准（NCC）建立。然而，其预后价值仍需验证。对 425 例在异基因干细胞移植后存活 100 天以上的患者进行了回顾性分析，并采用 NCC 进行重新分类。根据慢性 GVHD（cGVHD）发病时和高峰期 NIH 全球评分，比较 GVHD 特异性生存（GSS）和复发累积发生率。在 346 例采用修订版西雅图标准诊断为 cGVHD 的患者中，317 例患者根据 NCC 被重新分类为经典 cGVHD（n = 144）和重叠综合征（n = 173）。发病时 NIH 全球评分轻度（43.2%）、中度（42.3%）和重度（14.5%），而高峰期 cGVHD 更常见中度（55.5%）和重度（31.6%）。中位随访时间为 34 个月，发病时和高峰期 NIH 全球评分重度组的 5 年 GSS 明显差于中度/轻度组：发病时分别为 50.9%±7.8%、89.7%±3.2%和 93.5%±2.4%（P<0.001），高峰期分别为 69.1%±5.2%、93.2%±2.1%和 97.3%±2.7%（P<0.001）。多因素分析证实发病时和高峰期 NIH 全球评分重度是 GSS 的不良预后因素。发病时和高峰期严重程度组之间的复发累积发生率无差异。总之，新的 NIH 全球评分系统显示，在长期移植结局方面，可以将患者分为高危组（有严重 cGVHD 级别的患者）。
