aGvHD,   cGvHD,  GvHD Prophylaxis

Position statement on standardized terminology and guidance for graft-versus-host disease assessment by GvHD experts from the EBMT, the NIH, and the CIBMTR

In a recent issue of Bone Marrow Transplantation, Helene M. Schoemans, Stephanie J. Lee, James L. Ferrara, Daniel Wolff, John E. Levine, Kirk R. Schultz, Bronwen E. Shaw, Mary E. Flowers, Tapani Ruutu, Hildegard Greinix, Ernst Holler, Grzegorz Basak, Rafael F. Duarte, and Steven Z. Pavletic published a position statement that reviews the current guidelines and terminology regarding acute and chronic graft-verus-host disease (GvHD) on behalf of the EBMT (European Society for Blood and Marrow Transplantation) Transplant Complications Working Party and the “EBMT−NIH (National Institutes of Health)−CIBMTR (Center for International Blood and Marrow Transplant Research) GvHD Task Force.”

The review is intended to support transplantation societies in managing patients affected by, or suspected of having GvHD and also proposing consensus definitions for numerous key terms based on currently available guidelines such as the Mount Sinai Acute GvHD International Consortium (MAGIC) criteria for acute GvHD and the NIH 2014 criteria for chronic GvHD.

The authors stated that they believe that “adherence to a common set of GvHD assessment criteria is vitally important to improve the quality of data, compare results of retrospective studies and prospective clinical trials, and make therapeutic recommendations based on quality evidence. To assist the dissemination of these recommendations, a web-application based on this position statement is available (https://www.uzleuven.be/egvhd).”

Three main issues were highlighted by the authors:
  1. Standardized assessments of GvHD: a historical perspective
  • Acute GvHD (aGvHD) definitions
  • Chronic GvHD (cGvHD) definitions
  1. Application to clinical practice
  • Assessment of GvHD severity
  • Non-GvHD causes of organ impairment
  • Organ-specific manifestation
  • Overlap chronic GvHD
  • Specific guidance for the assessment of chronic GvHD
    • Skin, muscle, and fascia involvement
    • Scheduling pulmonary function tests and genital exams
    • Controversies in chronic GvHD
  • Pediatric considerations
  1. A standardized GvHD terminology
  • GvHD clinical activity
  • GvHD onset – the first episode
  • Response to steroids – refractoriness or resistance

In summary, the authors support the use of the MAGIC criteria for aGvHD assessment, and the NIH 2014 criteria for cGvHD diagnosis as these are the most up-to-date and comprehensive guidelines to date. The full article can be found here for more information:  https://www.nature.com/articles/s41409-018-0204-7.

References
  1. Schoemans H.M. et al. EBMT-NIH-CIBMTR Task Force position statement on standardized terminology & guidance for graft-versus-host disease assessment. Bone Marrow Transplant2018 Jun 5. DOI: 1038/s41409-018-0204-7. [Epub ahead of print]
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