Natural History Study of Clinical and Biological Factors Determining Outcomes in Chronic Graft-Versus-Host Disease

Background:

• Chronic graft-versus-host disease (cGVHD) is a multi-organ alloimmune and autoimmune disorder that occurs following allogeneic hematopoietic stem cell transplantation (alloHSCT). It is characterized by immune dysregulation, immunodeficiency, impaired organ function, and decreased survival.
• Each year about 8000 patients receive allogeneic hematopoietic stem cell transplant (alloHSCT) in North America and about 50% of patients who are transplanted develop cGVHD.
• Chronic GVHD is also a disorder that simultaneously affects many organ systems in highly variable fashion and requires complex and coordinated medical management by multiple medical specialties. There is an urgent need for progress in understanding and effective treatments for cGVHD as it is one of most serious complications of cancer therapy and hematopoietic stem cell transplantation.

Objectives:

• To establish a multidisciplinary clinic infrastructure for study of the pathogenesis and natural history of cGVHD
• To prospectively identify clinical and biological prognostic markers in patients with cGVHD
• To develop clinically relevant cGVHD grading scales
• To identify novel biological characteristics of cGVHD and to describe them in the context of clinical history and presentation
• To identify potential clinical and biological markers of cGVHD activity
• To improve understanding of the biology of cGVHD-associated graft-versus-tumor effects
• To identify potential patients for cGVHD treatment protocols at the NCI and NIH

Eligibility:

-Patients age 1 and older referred by the primary transplant physician for the evaluation of chronic graft-versus-host disease independent of underlying diagnosis.

Design:

• Patient undergoes initial clinical and laboratory multi-specialty work-up at the NCI cGVHD clinic
• Minimally invasive biopsies and rarely, deep tissue biopsy may be obtained to confirm the diagnosis and/or rule-out other pathologic process (in adults only)
• Long term data collection for evaluation of long-term outcomes will be conducted annually as feasible.

• INCLUSION CRITERIA:

• Any patient age 1 and older referred by the primary transplant physician for the evaluation of chronic graft-versus-host disease independently of age or underlying diagnosis
• Patient or the patient's legal representative is able and willing to provide consent.

Exclusion criteria

• Significant medical condition or any other significant circumstance that could in the PIs assessment affect the patient's ability to tolerate, comply, or complete the study
• Patients who in the PIs assessment have a life expectancy <3 months.

Note: Because it is not always possible to make a clear clinical distinction between acute and chronic GVHD, patients with acute GVHD are not a-priori excluded until the possibility of chronic GVHD is reliably excluded on the basis of the clinical assessments in the cGVHD clinic.

• Pregnant women are excluded from this study because multiple tests would need to be excluded for safety of the patient and the fetus.

Inclusion criteria

for control subjects without cGVHD:

• Age 1 and older
• Patient has undergone Allo-HSCT
• Patient or the patient's parent/guardian is able and willing to provide consent

Exclusion criteria

for control subjects without cGVHD:

• Active GVHD
• In the previous three months have received systemic immunosuppressant therapy for the treatment of GVHD
• In the previous three months have received therapy for malignancy