Organ Changes Associated with Provider-Assessed Responses in Patients with Chronic Graft-versus-Host Disease

Paul J. Martin, Barry E. Storer, Jeanne Palmer, Madan H. Jagasia, George L. Chen, Raewyn Broady, Mukta Arora, Joseph A. Pidala, Betty K. Hamilton, Stephanie J. Lee

Research output: Contribution to journalArticle

Abstract

Assessments of overall improvement and worsening of chronic graft-versus-host disease (GVHD) manifestations by the algorithm recommended by National Institutes of Health (NIH) response criteria do not align closely with those reported by providers, particularly when patients have mixed responses with improvement in some manifestations but worsening in others. To elucidate the changes that influence provider assessment of response, we used logistic regression to generate an overall change index based on specific manifestations of chronic GVHD measured at baseline and 6 months later. We hypothesized that this overall change index would correlate strongly with overall improvement as determined by providers. The analysis included 488 patients from 2 prospective observational studies who were randomly assigned in a 3:2 ratio to discovery and replication cohorts. Changes in bilirubin and scores of the lower gastrointestinal tract, mouth, joint/fascia, lung, and skin were correlated with provider-assessed improvement, suggesting that the main NIH response measures capture relevant information. Conversely, changes in the eye, esophagus, and upper gastrointestinal tract did not correlate with provider-assessed response, suggesting that these scales could be modified or dropped from the NIH response assessment. The area under the receiver operator characteristic curve in the replication cohort was 0.72, indicating that the scoring algorithm for overall change based on NIH response measures is not well calibrated with provider-assessed response.

Original languageEnglish (US)
JournalBiology of Blood and Marrow Transplantation
DOIs
StatePublished - Jan 1 2019

Fingerprint

National Institutes of Health (U.S.)
Graft vs Host Disease
Lower Gastrointestinal Tract
Upper Gastrointestinal Tract
Fascia
Bilirubin
Esophagus
Observational Studies
Mouth
Joints
Logistic Models
Prospective Studies
Lung
Skin

Keywords

  • Chronic graft-versus-host disease
  • Hematopoietic cell transplantation
  • Treatment response

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Organ Changes Associated with Provider-Assessed Responses in Patients with Chronic Graft-versus-Host Disease. / Martin, Paul J.; Storer, Barry E.; Palmer, Jeanne; Jagasia, Madan H.; Chen, George L.; Broady, Raewyn; Arora, Mukta; Pidala, Joseph A.; Hamilton, Betty K.; Lee, Stephanie J.

In: Biology of Blood and Marrow Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

Martin, Paul J. ; Storer, Barry E. ; Palmer, Jeanne ; Jagasia, Madan H. ; Chen, George L. ; Broady, Raewyn ; Arora, Mukta ; Pidala, Joseph A. ; Hamilton, Betty K. ; Lee, Stephanie J. / Organ Changes Associated with Provider-Assessed Responses in Patients with Chronic Graft-versus-Host Disease. In: Biology of Blood and Marrow Transplantation. 2019.
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