The NIH Clinical Scoring of Organ Systems

EP: 1.Graft versus Host Disease Background

EP: 2.Overview of GVHD Risk Factors

EP: 3.Current GVHD Prophylaxis Strategies

EP: 4.Signs and Symptoms of Acute and Chronic GVHD

EP: 5.Statistics on the Incidence of Chronic GVHD

EP: 6.Identification of Patients at High Risk for GVHD

EP: 7.Assessment of Chronic GVHD Symptoms

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EP: 8.The NIH Clinical Scoring of Organ Systems

EP: 9.The Chronic GVHD Treatment Paradigm

EP: 10.Patient Case: A 48-Year-Old Man with Chronic GVHD

EP: 11.Treatment Goals for a Patient With Chronic GVHD

EP: 12.Steroid-Refractory Chronic GVHD Background

EP: 13.Therapy Options for Steroid-Refractory Chronic GVHD

EP: 14.Ibrutinib as Second-Line Therapy for Steroid-Refractory Chronic GVHD

EP: 15.The iNTEGRATE Trial: Ibrutinib With Prednisone as First-Line Therapy for cGVHD

EP: 16.The REACH3 Clinical Trial of Ruxolitinib in Chronic GVHD

EP: 17.Clinical Experience with Ruxolitinib for cGVHD

EP: 18.The ROCKstar Study of Belumosudil in cGVHD

EP: 19.Real-World Experience with Belumosudil

EP: 20.Summary of Axatilimab for cGVHD

EP: 21.Therapy Selection for Patients with Chronic GVHD

EP: 22.Discussion of Long-Term Effects of GVHD Therapy

EP: 23.Future Directions in Graft Versus Host Disease

Transcript:

Yi-Bin Chen, MD: Back in the day, when I was training, chronic graft-versus-host disease [GVHD] was classified into limited versus extensive. That was a lot easier than what we have now. But what we have now was developed for reasons. Corey, do you want to take us through a quick jog of how we grade chronic GVHD in the modern era?

Corey S. Cutler, MD, MPH, FRCPC: Sure. So the modern staging and grading of chronic GVHD really owes a lot to people like Stephanie Lee and Steve Pavletic and Paul Martin who helped convene an NIH [National Institutes of Health] Consensus Conference, where we really came up with a lot of these definitions. The way we now stage chronic GVHD is with this NIH scoring system, and in the scoring system each individual organ is looked at in isolation and given a score from 0-3 with a score of 0 meaning no symptoms or symptoms that are really entirely attributable to a non-GVHD cause. And then with increasing severity, from 1-3 with more and more symptoms, with a score of 3, generally indicating a functional limitation because of the impact of that organ on the patient. And so, one takes the individual organs and looks at all of the organs put together to get a composite score. And the way I remember the composite score is that someone with mild chronic GVHD can only have up to 2 organs involved, and each of those organs can only be a score severity of 1 each, and the lung cannot be involved. At the other end of the spectrum are patients who are diagnosed with severe chronic GVHD, and this is anybody who has any individual organ with a score of 3, implying a functional limitation or a lung score of 2. So any 3 or a lung 2 makes you severe, and everybody else is in the moderate category. The moderate does represent the majority of patients.

Yi-Bin Chen, MD: Now that’s a great summary. Where it’s truly helped is doing large multicenter clinical trials. It’s really helped us sort of communicate and be able to measure response to a much more reliable degree than what we had before. I think people have also pointed out the limitations of this one. One, it takes a long time to do these assessments, and there is still some subjectivity to it all. And so, it does fall to that a little bit. However, I think a big push these days is in chronic graft-versus-host disease trials to also incorporate patient-reported outcomes to try and validate sort of the grading by the NIH system as well as the responses. And that’s been a huge push to help us better interpret the results.

Transcript edited for clarity.