Classificatie chronische GvHD

SCORE 0 SCORE 1 SCORE 2 SCORE 3
PERFORMANCE SCORE:
KPS / ECOG / LPS

Asymptomatic and fully active
(ECOG 0; KPS
or LPS 100%)

Symptomatic, fully ambulatory, restricted only in physically strenuous activity
(ECOG 1, KPS or LPS 80-90%)

Symptomatic, ambulatory, capable of selfcare, > 50% of waking hours out of bed
(ECOG 2, KPS or LPS 60-70%)

Symptomatic, limited self-care, > 50% of waking hours in bed
(ECOG 3-4, KPS or LPS < 60%)
SKIN 1 
Score % BSA

GVHD features to be scored by BSA:

  • Maculopapular rash/erythema
  • Lichen planus-like features
  • Sclerotic features
  • Papulosquamous lesions or ichthyosis>
  • Keratosis pilaris-like GVHD

No BSA involved

1-18% BSA

19-50% BSA

> 50% BSA
Skin features score
No sclerotic features

Superficial sclerotic features ‘not hidebound’ (able to pinch)

One or more of the features:
– Deep sclerotoc features
– ‘Hidebound’ (unable to pinch)
– Impaired mobility
– Ulceration
MOUTH
No symptoms

Mild symptoms with disease signs but not limiting oral intake significantly

Moderate symptoms with disease signs with partial limitation of oral intake

Severe symptoms with disease signs on examination with major imitation of oral intake
EYES
No symptoms

Mild dry eye symptoms not affecting ADL (requirement of lubricant eyedrops ≤ 3 x per day)

Moderate dry eye symptoms partially affecting ADL (requiring lubricant ing eyedrops > 3 x per day or punctal plugs), WITHOUT new visionimpairment due to KCS

Severe dry eye symptoms significantly affecting ADL (special eyeware to relieve pain) OR unable to work because of ocular symptoms OR loss of vision due to KCS
GI TRACT
No symptoms

Symptoms without significant weight loss (< 5%)2

Symptoms associated with mild to moderate weight loss (5- 15%) or moderate diarrhea without significant interference with daily living)

Symptoms associated with significant weight loss > 15%, requires nutritional supplement for most calorie needs OR esophageal dilation OR severe diarrhea with significant interference with daily living
LIVER
Normal total bilirubin and ALT or AP < 3 x ULN

Normal total bilirubin with ALT ≥ 3-5 x ULN or AP ≥ 3 x ULN

Elevated total bilirubin but ≤ 3 mg/dl (≤ 50 µmol/L) or ALT > 5 x ULN

Elevated total bilirubin > 3 mg/dl (≥ 50 µmol/L)
LUNG score
FEV1 ≥ 80%

FEV1 60-79%

FEV1 40-59%

FEV1 ≤ 39%
JOINTS AND FASCIA
No symptoms

Mild tightness of arms or legs, normal or mild decreased range of motion (ROM) ANDnot affecting ADL

Tightness of arms or legs
OR
joint contractures, erythema thought due to fasciitis, moderate decrease ROM AND mild to moderate limitation of ADL

Contractures WITH significant decrease of ROM AND significant limitation of ADL (unable to tie shoes, button shirts, dress self etc.)
GENITAL TRACT
No symptoms

Mild signs4 and females with or without discomfort on gynecologic exam

Moderate signs and may have symptoms with discomfort on gynecologic exam

Severe signs with or without symptoms
OVERALL GVHD SEVERITY (Opinion of the evaluator)
No GVHD

Mild

Moderate

Severe

Other indicators, clinical manifestations or complications related to chronic GVHD
(check all that apply and assign a score to its severity (0-3) based on its functional impact where applicable (none – 0, mild -1, moderate -2, severe -3)

Ascites (serositis)
None

Mild

Moderate

Severe
Myasthenia Gravis
None

Mild

Moderate

Severe
Polymyositis
None

Mild

Moderate

Severe
Platelets < 100,000/μl
None

Mild

Moderate

Severe
Pericardial Effusion
None

Mild

Moderate

Severe
Nephrotic syndrome
None

Mild

Moderate

Severe
Weight loss > 5%2 without GI symptoms
None

Mild

Moderate

Severe
Pleural Effusion(s)
None

Mild

Moderate

Severe
Peripheral Neuropathy
None

Mild

Moderate

Severe
Eosinophilia > 500μl
None

Mild

Moderate

Severe
Other
None

Mild

Moderate

Severe

ECOG indicates Eastern Cooperative Oncology Group; KPS, Karnofsky Performance Status; LPS, Lansky Performance Status; BSA, body surface area; ADL, activities of daily living; AP, alkaline phosphatase; ALT, alanine aminotransferase; ULN, normal upper limit.

1 Skin scoring should use both percentage of BSA involved by disease signs and the cutaneous features scales. When a discrepancy exists between the percentage of total body surface (BSA) score and the skin feature score, OR if superficial sclerotic features are present (Score 2), but there is impaired mobility or ulceration (Score 3), the higher level should be used for the final skin scoring.
2 Weight loss within 3 months.
3 To be completed by specialist or trained medical providers.

Classificatie

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