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Improving Outcomes Assessment in Chronic GVHD

2 Years
Open (Enrolling)
Chronic Graft Versus Host Disease

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Trial Information

Improving Outcomes Assessment in Chronic GVHD

Chronic graft-versus-host disease (GVHD) is one of the most devastating long-term
complications after infusion of allogeneic hematopoietic stem cells, and it remains one of
the major barriers to successful transplantation. Relatively little progress has been made
in understanding and improving treatments for chronic GVHD over the last 20 years, and the
survival rate after diagnosis of chronic GVHD has barely improved despite advances in
supportive care. The National Institutes of Health convened a Consensus Conference on this
topic in June 2004 and recently published its recommendations on improving research methods
in a series of six papers.

In our study, we will establish a multi-center, observational, longitudinal cohort in order
to improve outcomes assessment in chronic GVHD with the specific aims of (1) validating
prognostic factors for risk stratification; and (2) defining significant variables for a
chronic GVHD activity index that predicts short-term (provider perception of change, patient
perception of change, and changes in immunosuppressive medications) and longer-term outcomes
(overall survival, time to discontinuation of systemic immunosuppressive therapy, and
functional impairments). This goal will be accomplished by assembling a large modern cohort
of people with chronic GVHD at four large core transplant centers. Approximately 700 people
(half prevalent cases, half incident cases) with chronic GVHD will be enrolled. Every 3-6
months we will collect both objective and subjective measures reflecting disease activity,
response to therapy, detailed physician assessments about organ involvement, and patient
self-assessments about symptoms, functional status, and quality of life. Data will be used
to test published hypotheses and the new recommendations emanating from the NIH Consensus
conference. We will also be able to provide the detailed data needed to understand modern
trends in chronic GVHD incidence, manifestations, and response to treatment. These studies
are needed to operationalize the recommendations of the NIH Consensus conference, advance
our understanding of chronic GVHD, and enhance our ability to conduct clinical trials.

Inclusion Criteria:

- Age greater than or equal to 2 years

- Prior allogeneic stem cell transplant, with any graft source, donor type, and GVHD
prophylaxis allowed

- Clinical or histologic diagnosis of chronic GVHD (overlap syndrome with acute GVHD is

- Need for systemic treatment, defined as any medication or intervention delivered
systemically, including extracorporeal photopheresis. If a patient only received
topical or local therapy at diagnosis, but subsequently requires systemic treatment,
they may be enrolled upon initiation of systemic therapy. (Note, these patients will
be classified as incident or prevalent cases depending on time from chronic GVHD
diagnosis, not start of systemic therapy)

- If a prevalent case (defined as enrollment three or more months after chronic GVHD
diagnosis), then subject must be within 2 years of stem cell infusion

- If an incident case (enrollment less than 3 months after chronic GVHD diagnosis) then
no limitation on time from transplantation

- No evidence of primary disease relapseProgression-free for their malignancy at
enrollment (no evidence of primary disease progression since transplant, although
residual disease may still be present)

- Evaluation at the transplant center at the time of study enrollment

- Signed, informed consent and if applicable, child assent

Exclusion Criteria:

- Inability to comply with study procedures

- Anticipated survival less than 6 months due to co-morbid disease

Type of Study:


Study Design:

Observational Model: Cohort, Time Perspective: Prospective

Outcome Measure:

Overall survival

Outcome Time Frame:

3 years

Safety Issue:


Principal Investigator

Stephanie J Lee, MD MPH

Investigator Role:

Principal Investigator

Investigator Affiliation:

Fred Hutchinson Cancer Research Center


United States: Institutional Review Board

Study ID:




Start Date:

September 2007

Completion Date:

May 2013

Related Keywords:

  • Chronic Graft Versus Host Disease
  • Chronic graft versus host disease
  • Allogeneic hematopoietic cell transplantation
  • Biomarkers
  • Response criteria
  • Surrogate endpoints
  • Natural history
  • Graft vs Host Disease



Fred Hutchinson Cancer Research Center Seattle, Washington  98109
Washington University School of Medicine Saint Louis, Missouri  63110
Medical College of Wisconsin Milwaukee, Wisconsin  53226
Stanford University Stanford, California  94305
Dana-Farber Cancer Institute Boston, Massachusetts  02115
University of Minnesota Minneapolis, Minnesota  55455
Vanderbilt University Nashville, Tennessee  37232-6305
H. Lee Moffitt Cancer Center Tampa, Florida  33612
Memorial Sloan Kettering New York, New York  10021