Brazilian Workshop on Diagnosis, Classification and Assessment of Severity of Chronic Graft-Versus-Host Disease According to the Criteria of the National institutes of Health

Chronic graft-versus-host disease (cGvHD) is a major cause of late mortality related to allogeneic hematopoietic stem cell transplantation (HSCT). The difficulty in standardizing cGvHD diagnostic criteria, classification and severity led the National Institute of Health (NIH) to develop a consensus project to these criteria. This proposal included the scores of involved sites and the overall assessment of severity classified as none, mild, moderate or severe. Validation of the NIH classification translated is the goal of a prospective multicenter study conducted by the GvHD Study Group Brazil-Seattle (GEDECH) in a cohort of patients with cGvHD transplanted in Brazil. The purpose of the workshop held in CEMO was to train physical examination, standardize diagnostic criteria and improve the filling of the detailed forms of the protocol by the participants. Five HSCT centers included representatives and the program encompassed practical assessment of the cases, training with the physiotherapists and discussion of results. Nine patients, under informed consent, agreed to be photographed before and be examined, in private rooms, by groups of three professionals at a time. The groups were supervised by a dermatologist and an oral medicine doctor. They had 20 minutes to evaluate each patient and fill the forms. In the next step, the patients were submitted to physiotherapy evaluation for strength and 2-minute walk tests. Finally, using the summary of the cases, the images and forms, the coordinators discussed in plenary session, aspects and difficulties associated with this methodology and protocol. Participants did not scored the percentage grade of each type of lesion and agreed that 20 minutes per patient were inadequate. The main issues raised at the meeting were: difficulty in establishing the percentage of erythema in movable and nonmovable sclerosis; the need to describe the changes in each region or the dominant aspect of the lesion; the definition of poikiloderma; the relationship between scale A (gravity) and scale B scores (symptoms) in the overall assessment of cGvHD; disagreement in understanding the degree of restriction of oral intake and between the methodologies used in strength and walk tests. The workshop clarified several doubts about the clinical assessment of cGvHD and suggestions will be applied in extending the protocol to other centers in Brazil.