CONSENSUS CONFERENCE ON ACUTE GVHD GRADING

Grading acute graft-versus-host disease (GVHD) is usually based on qua ntification of rash, serum bilirubin and diarrhea. Standard criteria h ave been developed and used for >20 years by most transplant centers, However, neither the standard GVHD grading system nor any of several r evisions has been validated in the context of GVHD prophylaxis with cy closporine. The 1994 Consensus Conference on Acute GVHD Grading held i n Keystone in January 1994 provided an opportunity to: (1) review data regarding these standard criteria; (2) determine if there are suffici ent data to revise these criteria; and (3) develop recommendations for reporting results of GVHD prevention trials. Data were provided for 8 249 patients from 12 large transplant centers and 2 transplant registr ies, Standard GVHD grading criteria were found to distinguish differen t mortality risks and treatment response rates, Analysis of new data s uggested that persistent nausea with histologic evidence of GVHD but n o diarrhea be included as stage 1 gastrointestinal GVHD, Additional st udies were recommended to evaluate heterogeneity of outcome within GVH D grades prior to making further revisions. To improve comparability b etween publications, reports of GVHD prevention trials should include an accurate description of the grading system used and should report a ctuarial rates of grades II-IV and III-IV GVHD corrected for graft fai lure and potential interventions for early relapse, Additional informa tion should include indications for therapy of GVHD and response.