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Interrater Reliability of Clinical Grading Measures for Cutaneous Chronic Graft-vs-Host Disease.

  • Cardones, Adela R1, 2, 3
  • Sullivan, Keith M1, 4
  • Green, Cindy5
  • Chao, Nelson J1, 4
  • Rowe-Nichols, Krista4
  • Bañez, Lionel L3
  • Burton, Claude S2
  • Horwitz, Mitchell E1, 4
  • Long, Gwynn D1, 4
  • Rao, Caroline L2, 3
  • Sarantopoulos, Stefanie1, 4
  • Sidhu-Malik, Navjeet2
  • Sung, Anthony D1, 4
  • Hall, Russell P 3rd2
  • 1 Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.
  • 2 Department of Dermatology, Duke University, Durham, North Carolina.
  • 3 Durham Veterans Affairs Medical Center, Durham, North Carolina.
  • 4 Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina.
  • 5 Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
Published Article
JAMA dermatology
Publication Date
Jul 01, 2019
DOI: 10.1001/jamadermatol.2018.5459
PMID: 30994873


Cutaneous chronic graft-vs-host disease (cGVHD) is common after allogeneic hematopoietic stem cell transplant and is often associated with poor patient outcomes. A reliable and practical method for assessing disease severity and response to therapy among these patients is urgently needed. To evaluate the interrater agreement and reliability of skin-specific and range of motion (ROM) variables of the 2014 National Institutes of Health (NIH) response criteria for cGVHD and a skin sclerosis grading scale (SSG). In this observational study performed at a single tertiary academic center, 6 academic blood and marrow transplant specialists and 4 medical dermatologists examined 8 patients with diagnosed cutaneous cGVHD on July 10, 2015. The patient cohort was enriched for patients with sclerotic features. Each patient was evaluated by using the skin-specific and ROM criteria of the 2014 NIH response criteria for cGVHD and an SSG ranging from 0 to 3. Each patient was also asked to complete quality-of-life scoring instruments. Interrater agreement and reliability were estimated by calculating the Krippendorff α and Cohen κ statistics. Data were analyzed from September 29, 2015, through November 22, 2018. Estimation of interrater agreement by interclass coefficient (Krippendorff α and Cohen κ statistics) for the skin-specific and ROM components of the 2014 NIH Response Criteria for Chronic GVHD and for the SSG. The median age of the patients evaluated was 54 years (range, 46-58 years). Patients were predominantly male (6 [75%]). Six of the 8 patients had a predominantly sclerotic cutaneous phenotype. Interrater agreement among our experts was acceptable for NIH skin feature score (0.68; 95% CI, 0.30-0.86) and good for NIH ROM scoring (0.80; 95% CI, 0.68-0.86). Dermatologists had acceptable agreement for NIH skin GVHD score (0.69; 95% CI, 0.25-0.82) and skin feature score (0.78; 95% CI, 0.17-0.98), good agreement in ROM grading (0.85; 95% CI, 0.69-0.90), and near perfect agreement in identifying sclerosis (0.82; 95% CI, 0.27-0.97). Although dermatologists had acceptable agreement in NIH skin GVHD score and skin features score, near perfect agreement in identifying cutaneous sclerosis, better agreement in grading severity of cutaneous cGVHD, especially in the intermediate grades, appears to be needed.

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