Patient-reported quality of life is associated with severity of chronic graft-versus-host disease as measured by NIH criteria: Report on baseline data from the Chronic GVHD Consortium
ABSTRACT Quality of life (QOL) after hematopoietic cell transplantation (HCT) is compromised by chronic GVHD. In a prospectively assembled multicenter cohort of adults with chronic GVHD (n = 298), we examined the relationship between chronic GVHD severity defined by National Institutes of Health (NIH) criteria and QOL as measured by the SF-36 and FACT-BMT instruments at time of enrollment. Chronic GVHD severity was independently associated with QOL, adjusting for age. Compared with population normative data, SF-36 scores were more than a SD (10 points) lower on average for the summary physical component score (PCS) and role-physical subscale, and significantly lower (with magnitude 4-10 points) for several other subscales. Patients with moderate and severe cGVHD had PCS scores comparable with scores reported for systemic sclerosis, systemic lupus erythematosus, and multiple sclerosis, and greater impairment compared with common chronic conditions including diabetes, hypertension, and chronic lung disease. Moderate to severe cGVHD as defined by NIH criteria is associated with significant compromise in multiple QOL domains, with PCS scores in the range of other systemic autoimmune diseases. Compromised QOL provides a functional assessment of the effects of chronic GVHD, and may be measured in cGVHD clinical studies using either the SF-36 or the FACT-BMT.
- SourceAvailable from: William Joseph Hogan
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- "The utilization of peripheral blood as a preferred stem cell source for allografts may have led to an increased incidence of cGVHD . Aside from being the leading cause of treatment-related mortality among long-term survivors of allo-SCT, it also has a significant impact on quality of life . Corticosteroids remain the backbone for initial cGVHD treatment , but overall prognosis remains poor despite a half the patients responding to this therapy. "
ABSTRACT: Background The safety of extracorporeal photopheresis (ECP) in steroid-refractory chronic graft-versus-host disease (SR-cGVHD) has been explored in multiple studies but reported response rates (RR) vary significantly across studies. Methods We conducted a meta-analysis to assess the efficacy of ECP for SR-cGVHD. A search of electronic databases for studies published between 1984 and 2012 was conducted. End points included RR: complete response (CR), overall response rates (ORR), and organ-specific RR. The initial search generated 312 studies, of which 18 met the selection criteria (N=595). A random effects model was used for pooled rates. Results Pooled CR rates and ORR were 29% (confidence interval [CI], 19-42%) and 64% (CI, 65-82%), respectively. One-year overall survival was available for 4 studies only and was 49% (CI, 29-70%). The pooled RR for skin, liver, ocular, oral, lung, gastrointestinal and musculoskeletal SR-cGVHD was 74%, 68%, 60%, 72%, 48%, 53%, and 64%, respectively. There was a significant heterogeneity among studies due to differences in ECP schedules and duration. No significant differences in responses to ECP for pediatric and adult populations were found. Sensitivity analysis could not be undertaken due to a limited number of prospective studies. Conclusion ECP is an effective therapy for oral, skin, and liver SR-cGVHD, with modest activity in lung and gastrointestinal SR-cGVHD.Blood Research 06/2014; 49(2):100-6. DOI:10.5045/br.2014.49.2.100
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- "Response to treatment should be documented at each clinic visit and formal staging by NIH criteria (Filipovich et al, 2005) should be recorded every 3 months. It has been shown that quality of life can be severely affected in patients with cGvHD and it is important to make a formal assessment of quality of life using a validated questionnaire (Pidala et al, 2011). Suitable questionnaires for adult patients include the FACT-BMT, SF-36 questionnaire, EORTC QLQ-C30 and the Lee cGvHD symptom scale (McQuellon et al, 1997; Kopp et al, 2000; Lee et al, 2002b; Pidala et al, 2011). "
ABSTRACT: A joint working group established by the Haemato-oncology subgroup of the British Committee for Standards in Haematology and the British Society for Bone Marrow Transplantation has reviewed the available literature and made recommendations for the supportive care and management of organ-specific complications of chronic graft-versus-host disease (cGvHD). This guideline includes recommendations for the specific therapy of skin, oral, liver, gut, lung, ocular and genital manifestations of cGvHD and for the supportive care of these patients, including vaccinations and prophylaxis against infection. The goal of treatment should be effective control of GvHD while minimizing the risk of toxicity and relapse.British Journal of Haematology 04/2012; 158(1):62-78. DOI:10.1111/j.1365-2141.2012.09131.x · 4.71 Impact Factor
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ABSTRACT: Seule perspective de guérison de certaines hémopathies malignes, l’allogreffe de cellules souches hématopoïétiques comporte des risques de morbimortalité significatifs. La morbidité est notamment liée à l’incidence de la réaction du greffon contre l’hôte (graft versus host disease, GVHD). Quand elle n’engage pas le pronostic vital des patients, cette réaction a un impact important sur la qualité de vie des patients. Ses répercussions physiques affectent l’image corporelle, l’image et l’estime de soi. Les retentissements psychiques dépassent la symptomatologie anxieuse ou dépressive, puisque cette GVHD viendra altérer le processus d’intégration psychique de la greffe et les remaniements identitaires qu’elle peut induire.Psycho-Oncologie 03/2013; 7(1). DOI:10.1007/s11839-013-0403-9 · 0.13 Impact Factor