Inamoto Y, Jagasia M, Wood W A, Pidala J, Palmer J, Khera N, Weisdorf D, Carpenter P A, Flowers M E D, Jacobsohn D, Martin P J, Lee S J, Pavletic S Z
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Hematology and Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, TN, USA.
Bone Marrow Transplant. 2014 Apr;49(4):532-8. doi: 10.1038/bmt.2013.225. Epub 2014 Jan 27.
The 2005 National Institutes of Health (NIH) consensus criteria for chronic GVHD have set standards for reporting. Many questions, however, have arisen regarding their implementation and utilization. To identify perceived areas of controversy, we conducted an international survey on diagnosis and scoring of chronic GVHD. Agreement was observed for 50-83% of the 72 questions in 7 topic areas. There was agreement on the need for modifying criteria in six situations: two or more distinctive manifestations should be enough to diagnose chronic GVHD; symptoms that are not due to chronic GVHD should be scored differently; active disease and fixed deficits should be distinguished; a minimum threshold body surface area of hidebound skin involvement should be required for a skin score of 3; asymptomatic oral lichenoid changes should be considered a score 1; and lung biopsy should be unnecessary to diagnose chronic GVHD in a patient with bronchiolitis obliterans as the only manifestation. The survey also identified 26 points of controversy. Whenever possible, studies should be conducted to confirm the appropriateness of any revisions. In cases where data are not available, clarification of the NIH recommendations by consensus is necessary. This survey should inform future research in the field and revisions of the current consensus criteria.
2005年美国国立卫生研究院（NIH）发布的慢性移植物抗宿主病（GVHD）共识标准为报告设定了规范。然而，在其实施和应用方面出现了许多问题。为了确定存在争议的领域，我们针对慢性GVHD的诊断和评分开展了一项国际调查。在7个主题领域的72个问题中，50%-83%的问题达成了共识。在六种情况下，对于修改标准达成了一致意见：两种或更多独特表现应足以诊断慢性GVHD；非慢性GVHD所致症状的评分应有所不同；应区分活动性疾病和固定性缺陷；皮肤评分为3分时，应要求有最低阈值的体表面积出现皮肤紧绷受累；无症状的口腔苔藓样改变应视为评分为1；对于仅以闭塞性细支气管炎为唯一表现的患者，诊断慢性GVHD时无需进行肺活检。该调查还确定了26个争议点。只要有可能，就应开展研究以证实任何修订的合理性。在缺乏数据的情况下，有必要通过共识来阐明NIH的建议。这项调查应为该领域未来的研究及当前共识标准的修订提供参考。
