National Institutes of Health Chronic Graft-versus-Host Disease Staging in Severely Affected Patients: Organ and Global Scoring Correlate with Established Indicators of Disease Severity and Prognosis

Kristin Baird, Seth M. Steinberg, Lana Grkovic, Drazen Pulanic, Edward W. Cowen, Sandra A. Mitchell, Kirsten M. Williams, Manuel B. Datiles, Rachel Bishop, Carol W. Bassim, Jacqueline W. Mays, Dean Edwards, Kristen Cole, Daniele N. Avila, Tiffany Taylor, Amanda Urban, Galen O. Joe, Leora E. Comis, Ann Berger, Pamela StrattonDan Zhang, James H. Shelhamer, Juan C. Gea-Banacloche, Claude Sportes, Daniel H. Fowler, Ronald E. Gress, Steven Z. Pavletic

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Between 2004 and 2010, 189 adult patients were enrolled on the National Cancer Institute's cross-sectional chronic graft-versus-host disease (cGVHD) natural history study. Patients were evaluated by multiple disease scales and outcome measures, including the 2005 National Institutes of Health (NIH) Consensus Project cGVHD severity scores. The purpose of this study was to assess the validity of the NIH scoring variables as determinants of disease severity in severely affected patients in efforts to standardize clinician evaluation and staging of cGVHD. Out of 189 patients enrolled, 125 met the criteria for severe cGVHD on the NIH global score, 62 of whom had moderate disease, with a median of 4 (range, 1-8) involved organs. Clinician-assigned average NIH organ score and the corresponding organ scores assigned by subspecialists were highly correlated (r = 0.64). NIH global severity scores showed significant associations with nearly all functional and quality of life outcome measures, including the Lee Symptom Scale, Short Form-36 Physical Component Scale, 2-minute walk, grip strength, range of motion, and Human Activity Profile. Joint/fascia, skin, and lung involvement affected function and quality of life most significantly and showed the greatest correlation with outcome measures. The final Cox model with factors jointly predictive for survival included the time from cGVHD diagnosis (>49 versus ≤49 months, hazard ratio [HR] = 0.23; P = .0011), absolute eosinophil count at the time of NIH evaluation (0-0.5 versus >0.5 cells/μL, HR = 3.95; P = .0006), and NIH lung score (3 versus 0-2, HR = 11.02; P < .0001). These results demonstrate that NIH organs and global severity scores are reliable measures of cGVHD disease burden. The strong association with subspecialist evaluation suggests that NIH organ and global severity scores are appropriate for clinical and research assessments, and may serve as a surrogate for more complex subspecialist examinations. In this population of severely affected patients, NIH lung score is the strongest predictor of poor overall survival, both alone and after adjustment for other important factors.

Original languageEnglish (US)
Pages (from-to)632-639
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume19
Issue number4
DOIs
StatePublished - Apr 1 2013

Fingerprint

National Institutes of Health (U.S.)
Graft vs Host Disease
Outcome Assessment (Health Care)
Lung
Quality of Life
Survival
National Cancer Institute (U.S.)
Fascia
Hand Strength
Articular Range of Motion
Natural History
Proportional Hazards Models
Eosinophils
Human Activities
Joints
Skin

Keywords

  • Chronic graft-versus-host disease
  • Consensus Criteria
  • Lung dysfunction
  • National Institutes of Health
  • Sclerotic skin
  • Stem cell transplant

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

National Institutes of Health Chronic Graft-versus-Host Disease Staging in Severely Affected Patients : Organ and Global Scoring Correlate with Established Indicators of Disease Severity and Prognosis. / Baird, Kristin; Steinberg, Seth M.; Grkovic, Lana; Pulanic, Drazen; Cowen, Edward W.; Mitchell, Sandra A.; Williams, Kirsten M.; Datiles, Manuel B.; Bishop, Rachel; Bassim, Carol W.; Mays, Jacqueline W.; Edwards, Dean; Cole, Kristen; Avila, Daniele N.; Taylor, Tiffany; Urban, Amanda; Joe, Galen O.; Comis, Leora E.; Berger, Ann; Stratton, Pamela; Zhang, Dan; Shelhamer, James H.; Gea-Banacloche, Juan C.; Sportes, Claude; Fowler, Daniel H.; Gress, Ronald E.; Pavletic, Steven Z.

In: Biology of Blood and Marrow Transplantation, Vol. 19, No. 4, 01.04.2013, p. 632-639.

Research output: Contribution to journalArticle

Baird, K, Steinberg, SM, Grkovic, L, Pulanic, D, Cowen, EW, Mitchell, SA, Williams, KM, Datiles, MB, Bishop, R, Bassim, CW, Mays, JW, Edwards, D, Cole, K, Avila, DN, Taylor, T, Urban, A, Joe, GO, Comis, LE, Berger, A, Stratton, P, Zhang, D, Shelhamer, JH, Gea-Banacloche, JC, Sportes, C, Fowler, DH, Gress, RE & Pavletic, SZ 2013, 'National Institutes of Health Chronic Graft-versus-Host Disease Staging in Severely Affected Patients: Organ and Global Scoring Correlate with Established Indicators of Disease Severity and Prognosis', Biology of Blood and Marrow Transplantation, vol. 19, no. 4, pp. 632-639. https://doi.org/10.1016/j.bbmt.2013.01.013
Baird, Kristin ; Steinberg, Seth M. ; Grkovic, Lana ; Pulanic, Drazen ; Cowen, Edward W. ; Mitchell, Sandra A. ; Williams, Kirsten M. ; Datiles, Manuel B. ; Bishop, Rachel ; Bassim, Carol W. ; Mays, Jacqueline W. ; Edwards, Dean ; Cole, Kristen ; Avila, Daniele N. ; Taylor, Tiffany ; Urban, Amanda ; Joe, Galen O. ; Comis, Leora E. ; Berger, Ann ; Stratton, Pamela ; Zhang, Dan ; Shelhamer, James H. ; Gea-Banacloche, Juan C. ; Sportes, Claude ; Fowler, Daniel H. ; Gress, Ronald E. ; Pavletic, Steven Z. / National Institutes of Health Chronic Graft-versus-Host Disease Staging in Severely Affected Patients : Organ and Global Scoring Correlate with Established Indicators of Disease Severity and Prognosis. In: Biology of Blood and Marrow Transplantation. 2013 ; Vol. 19, No. 4. pp. 632-639.
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AU - Joe, Galen O.

AU - Comis, Leora E.

AU - Berger, Ann

AU - Stratton, Pamela

AU - Zhang, Dan

AU - Shelhamer, James H.

AU - Gea-Banacloche, Juan C.

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N2 - Between 2004 and 2010, 189 adult patients were enrolled on the National Cancer Institute's cross-sectional chronic graft-versus-host disease (cGVHD) natural history study. Patients were evaluated by multiple disease scales and outcome measures, including the 2005 National Institutes of Health (NIH) Consensus Project cGVHD severity scores. The purpose of this study was to assess the validity of the NIH scoring variables as determinants of disease severity in severely affected patients in efforts to standardize clinician evaluation and staging of cGVHD. Out of 189 patients enrolled, 125 met the criteria for severe cGVHD on the NIH global score, 62 of whom had moderate disease, with a median of 4 (range, 1-8) involved organs. Clinician-assigned average NIH organ score and the corresponding organ scores assigned by subspecialists were highly correlated (r = 0.64). NIH global severity scores showed significant associations with nearly all functional and quality of life outcome measures, including the Lee Symptom Scale, Short Form-36 Physical Component Scale, 2-minute walk, grip strength, range of motion, and Human Activity Profile. Joint/fascia, skin, and lung involvement affected function and quality of life most significantly and showed the greatest correlation with outcome measures. The final Cox model with factors jointly predictive for survival included the time from cGVHD diagnosis (>49 versus ≤49 months, hazard ratio [HR] = 0.23; P = .0011), absolute eosinophil count at the time of NIH evaluation (0-0.5 versus >0.5 cells/μL, HR = 3.95; P = .0006), and NIH lung score (3 versus 0-2, HR = 11.02; P < .0001). These results demonstrate that NIH organs and global severity scores are reliable measures of cGVHD disease burden. The strong association with subspecialist evaluation suggests that NIH organ and global severity scores are appropriate for clinical and research assessments, and may serve as a surrogate for more complex subspecialist examinations. In this population of severely affected patients, NIH lung score is the strongest predictor of poor overall survival, both alone and after adjustment for other important factors.

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KW - Consensus Criteria

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KW - National Institutes of Health

KW - Sclerotic skin

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