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Clinical significance of subcategory and severity of chronic graft-versus-host disease evaluated by National Institutes of Health consensus criteria

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Abstract

To evaluate the clinical significance of subcategory and severity of chronic graft-versus-host disease (GVHD) as defined by the National Institutes of Health (NIH) consensus criteria, we retrospectively studied 211 patients with hematologic neoplasms who survived beyond 100 days after allogeneic hematopoietic cell transplantation. Endpoints included chronic GVHD-specific survival (cGSS), duration of immunosuppressive treatment, and non-relapse mortality (NRM). A total of 96 patients fulfilled the NIH diagnostic criteria for cGVHD. In univariable analysis, patients with NIH overlap syndrome tended to exhibit lower cGSS compared to those with NIH classic cGVHD [hazard ratio (HR) = 2.76, P = 0.060], while patients with severe cGVHD at onset had a significantly lower cGSS compared to those with mild-to-moderate cGVHD (HR = 3.10, P = 0.034). The duration of immunosuppressive treatment was not significantly affected by either subcategory or severity of NIH cGVHD. In multivariable analysis treating cGVHD as a time-dependent covariate, development of overlap syndrome (HR = 3.90, P = 0.014) or severe cGVHD at peak worsening (HR = 6.21, P < 0.001) was significantly associated with higher risk of NRM compared to the absence of cGVHD. Our results suggest that both the subcategory and severity of NIH cGVHD are partly correlated with cGSS and may play a useful role in distinguishing patients at high risk for NRM, warranting validation of this approach through future prospective studies.

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Acknowledgments

The authors are grateful to Rie Goi and Mika Kobayashi, for their expert data management and secretarial assistance, and all the staff of our transplant team for their dedicated care of the patients and donors.

Conflict of interest

The authors have no conflict of interest to declare.

Author information

Author notes

  1. Junya Kanda

    Present address: Division of Cellular Therapy, Duke University Medical Center, Durham, NC, USA

Authors and Affiliations

  1. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan

    Takayuki Sato, Tatsuo Ichinohe, Junya Kanda, Kouhei Yamashita, Tadakazu Kondo, Takayuki Ishikawa, Takashi Uchiyama & Akifumi Takaori-Kondo

Authors
  1. Takayuki Sato
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  2. Tatsuo Ichinohe
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  3. Junya Kanda
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  4. Kouhei Yamashita
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  5. Tadakazu Kondo
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  6. Takayuki Ishikawa
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  7. Takashi Uchiyama
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  8. Akifumi Takaori-Kondo
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Corresponding author

Correspondence to Tatsuo Ichinohe.

Additional information

T. Uchiyama: Deceased.

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Sato, T., Ichinohe, T., Kanda, J. et al. Clinical significance of subcategory and severity of chronic graft-versus-host disease evaluated by National Institutes of Health consensus criteria. Int J Hematol 93, 532–541 (2011). https://doi.org/10.1007/s12185-011-0820-0

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  • DOI: https://doi.org/10.1007/s12185-011-0820-0

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