Benefits and challenges with diagnosing chronic and late acute GVHD in children using the NIH consensus criteria

Geoffrey D.E. Cuvelier, Eneida R. Nemecek, Justin T. Wahlstrom, Carrie L. Kitko, Victor A. Lewis, Tal Schechter, David A. Jacobsohn, Andrew C. Harris, Michael A. Pulsipher, Henrique Bittencourt, Sung Won Choi, Emi H. Caywood, Kimberly A. Kasow, Monica Bhatia, Benjamin R. Oshrine, Allyson Flower, Sonali Chaudhury, Donald Coulter, Joseph H. Chewning, Michael JoyceSüreyya Savaşan, Anna B. Pawlowska, Gail C. Megason, David Mitchell, Alexandra C. Cheerva, Anita Lawitschka, Lori J. West, Bo Pan, Yazid N. Al Hamarneh, Anat Halevy, Kirk R. Schultz

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)304-316
Number of pages13
JournalBlood
Volume134
Issue number3
DOIs
StatePublished - Jul 18 2019

Fingerprint

Graft vs Host Disease
Grafts
Transplants
National Institutes of Health (U.S.)
Pediatrics
Health
Bronchiolitis Obliterans
Hematologic Diseases
Hematopoietic Stem Cell Transplantation
Advisory Committees

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Cuvelier, G. D. E., Nemecek, E. R., Wahlstrom, J. T., Kitko, C. L., Lewis, V. A., Schechter, T., ... Schultz, K. R. (2019). Benefits and challenges with diagnosing chronic and late acute GVHD in children using the NIH consensus criteria. Blood, 134(3), 304-316. https://doi.org/10.1182/blood.2019000216

Benefits and challenges with diagnosing chronic and late acute GVHD in children using the NIH consensus criteria. / Cuvelier, Geoffrey D.E.; Nemecek, Eneida R.; Wahlstrom, Justin T.; Kitko, Carrie L.; Lewis, Victor A.; Schechter, Tal; Jacobsohn, David A.; Harris, Andrew C.; Pulsipher, Michael A.; Bittencourt, Henrique; Choi, Sung Won; Caywood, Emi H.; Kasow, Kimberly A.; Bhatia, Monica; Oshrine, Benjamin R.; Flower, Allyson; Chaudhury, Sonali; Coulter, Donald; Chewning, Joseph H.; Joyce, Michael; Savaşan, Süreyya; Pawlowska, Anna B.; Megason, Gail C.; Mitchell, David; Cheerva, Alexandra C.; Lawitschka, Anita; West, Lori J.; Pan, Bo; Al Hamarneh, Yazid N.; Halevy, Anat; Schultz, Kirk R.

In: Blood, Vol. 134, No. 3, 18.07.2019, p. 304-316.

Research output: Contribution to journalArticle

Cuvelier, GDE, Nemecek, ER, Wahlstrom, JT, Kitko, CL, Lewis, VA, Schechter, T, Jacobsohn, DA, Harris, AC, Pulsipher, MA, Bittencourt, H, Choi, SW, Caywood, EH, Kasow, KA, Bhatia, M, Oshrine, BR, Flower, A, Chaudhury, S, Coulter, D, Chewning, JH, Joyce, M, Savaşan, S, Pawlowska, AB, Megason, GC, Mitchell, D, Cheerva, AC, Lawitschka, A, West, LJ, Pan, B, Al Hamarneh, YN, Halevy, A & Schultz, KR 2019, 'Benefits and challenges with diagnosing chronic and late acute GVHD in children using the NIH consensus criteria', Blood, vol. 134, no. 3, pp. 304-316. https://doi.org/10.1182/blood.2019000216
Cuvelier GDE, Nemecek ER, Wahlstrom JT, Kitko CL, Lewis VA, Schechter T et al. Benefits and challenges with diagnosing chronic and late acute GVHD in children using the NIH consensus criteria. Blood. 2019 Jul 18;134(3):304-316. https://doi.org/10.1182/blood.2019000216
Cuvelier, Geoffrey D.E. ; Nemecek, Eneida R. ; Wahlstrom, Justin T. ; Kitko, Carrie L. ; Lewis, Victor A. ; Schechter, Tal ; Jacobsohn, David A. ; Harris, Andrew C. ; Pulsipher, Michael A. ; Bittencourt, Henrique ; Choi, Sung Won ; Caywood, Emi H. ; Kasow, Kimberly A. ; Bhatia, Monica ; Oshrine, Benjamin R. ; Flower, Allyson ; Chaudhury, Sonali ; Coulter, Donald ; Chewning, Joseph H. ; Joyce, Michael ; Savaşan, Süreyya ; Pawlowska, Anna B. ; Megason, Gail C. ; Mitchell, David ; Cheerva, Alexandra C. ; Lawitschka, Anita ; West, Lori J. ; Pan, Bo ; Al Hamarneh, Yazid N. ; Halevy, Anat ; Schultz, Kirk R. / Benefits and challenges with diagnosing chronic and late acute GVHD in children using the NIH consensus criteria. In: Blood. 2019 ; Vol. 134, No. 3. pp. 304-316.
@article{ec39671150fc45378ff9bbe7bc1c8a9f,
title = "Benefits and challenges with diagnosing chronic and late acute GVHD in children using the NIH consensus criteria",
abstract = "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.",
author = "Cuvelier, {Geoffrey D.E.} and Nemecek, {Eneida R.} and Wahlstrom, {Justin T.} and Kitko, {Carrie L.} and Lewis, {Victor A.} and Tal Schechter and Jacobsohn, {David A.} and Harris, {Andrew C.} and Pulsipher, {Michael A.} and Henrique Bittencourt and Choi, {Sung Won} and Caywood, {Emi H.} and Kasow, {Kimberly A.} and Monica Bhatia and Oshrine, {Benjamin R.} and Allyson Flower and Sonali Chaudhury and Donald Coulter and Chewning, {Joseph H.} and Michael Joyce and S{\"u}reyya Savaşan and Pawlowska, {Anna B.} and Megason, {Gail C.} and David Mitchell and Cheerva, {Alexandra C.} and Anita Lawitschka and West, {Lori J.} and Bo Pan and {Al Hamarneh}, {Yazid N.} and Anat Halevy and Schultz, {Kirk R.}",
year = "2019",
month = "7",
day = "18",
doi = "10.1182/blood.2019000216",
language = "English (US)",
volume = "134",
pages = "304--316",
journal = "Blood",
issn = "0006-4971",
publisher = "American Society of Hematology",
number = "3",

}

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.

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.

UR - http://www.scopus.com/inward/record.url?scp=85070114726&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070114726&partnerID=8YFLogxK

U2 - 10.1182/blood.2019000216

DO - 10.1182/blood.2019000216

M3 - Article

C2 - 31043425

AN - SCOPUS:85070114726

VL - 134

SP - 304

EP - 316

JO - Blood

JF - Blood

SN - 0006-4971

IS - 3

ER -