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

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 the NIH-CC; and (3) the clinical features and risk factors for cGVHD and 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 NIH-CC 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 NIH-CC 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 the NIH-CC in pediatrics is feasible and reliable; however, further refinement of the criteria specifically for children is needed.

Source: Blood - July 17, 2019 Category: Hematology Authors: Cuvelier, G. D. E., Nemecek, E. R., Wahlstrom, J. T., Kitko, C. L., Lewis, V. A., Schechter, T., Jacobsohn, D. A., Harris, A. C., Pulsipher, M. A., Bittencourt, H., Choi, S. W., Caywood, E. H., Kasow, K. A., Bhatia, M., Oshrine, B. R., Flower, A., Chaudhu Tags: Pediatric Hematology, Transplantation, Free Research Articles, CME article Source Type: research