TRANSPLANTATION Evaluation of NIH consensus criteria for classification of late acute and chronic GVHD

Historically, graft-versus-host disease (GVHD) beyond 100 days after hematopoi-etic cell transplantation (HCT) was called chronic GVHD, even if the clinical manifes-tations were indistinguishable from acute GVHD. In 2005, the National Institutes of Health (NIH) sponsored a consensus con-ference that proposed new criteria for diagnosis and classification of chronic GVHD for clinical trials. According to the consensus criteria, clinical manifesta-tions rather than time after transplanta-tion should be used in clinical trials to distinguish chronic GVHD from late acute GVHD, which includes persistent, recur-rent, or late-onset acute GVHD. We evalu-ated major outcomes according to the presence or absence of NIH criteria for chronic GVHD in a retrospective study of 740 patients diagnosed with historically defined chronic GVHD after allogeneic HCT between 1994 and 2000. The pres-ence or absence of NIH criteria for chronic GVHD showed no statistically significant association with survival, risks of nonre-lapse mortality or recurrent malignancy, or duration of systemic treatment. Ante-cedent late acute GVHD was associated with an increased risk of nonrelapse mor-tality and prolonged treatment among pa-tients with NIH chronic GVHD. Our results support the consensus recommendation that, with appropriate stratification, clini-cal trials can include patients with late acute GVHD as well as those with NIH chronic GVHD. (Blood. 2009;114:702-708