Grading acute graft-versus-host disease: time to reconsider

Area of Science:

• Hematology
• Immunology
• Transplantation Medicine

Background:

• Acute graft-versus-host disease (GVHD) is a frequent and severe complication following allogeneic blood and marrow transplantation (BMT).
• Current grading systems, such as the modified Glucksberg criteria, exhibit significant heterogeneity within grades.
• Variations in organ involvement (skin, liver, gut) contribute to inconsistencies in severity assessment.

Purpose of the Study:

• To critically review the ambiguities and limitations in current acute GVHD severity scoring systems.
• To propose specific, actionable recommendations for improving acute GVHD grading.
• To stimulate discussion within the BMT community regarding potential refinements and validation of revised scoring methods.

Main Methods:

• Analytical review of existing literature and clinical practices related to acute GVHD grading.
• Identification and categorization of ambiguities within the modified Glucksberg criteria.
• Formulation of proposals for enhanced severity scoring.

Main Results:

• Significant heterogeneity exists within established acute GVHD grades, impacting clinical management and research.
• Current scoring criteria do not fully capture the spectrum of organ-specific involvement and overall disease severity.
• Specific areas of ambiguity in scoring skin, liver, and gut GVHD were identified.

Conclusions:

• Refinement of acute GVHD scoring is necessary to reduce within-grade heterogeneity.
• The proposed analytical framework and specific recommendations aim to foster community consensus and guide future validation studies.
• Improved GVHD severity scoring will enhance clinical decision-making and facilitate more accurate comparisons across studies.