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Editorials
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chronic GvHD, using the most up-to date guidelines [Mount Sinai Acute GvHD International Consortium (MAGIC) for acute and NIH 2014 for chronic GvHD].
The study presented in this issue of the Journal4 was performed in 7 Belgian centers practising allogeneic hematopoietic stem cell transplantation (HSCT) and included 77 health care practitioners (HPCs), among whom 58 were physicians (75%), 15 were data managers (19%), and 4 held another position. They were invited to evaluate the diagnosis and severity score of 10 clinical vignettes (4 acute and 6 chronic GvHD) validated by a group of 10 separate GvHD experts (Expert Gold Standard) who implemented the latest guidelines. For their evaluation, the 77 HCPs were randomized to either use their usual GvHD assessment tools without the eGVHD App (No App group, n=40) or to use the eGVHD App (App group, n=37) (Figure 1).
The most frequently reported GvHD guidelines refer- enced by HPCs in the No App group were the Glucksberg5 and the NIH 20146 criteria. They assessed GvHD of the 10 case vignettes mostly by their own knowledge (62%) or by using the 2014 GvHD evaluation sheet (23%), the 2005 NIH evaluation sheet (15%), or a self-designed scoring document (15%). The use of the
Figure 1. Graft-versus-host disease (GvHD) assessment tools used in the study. Healthcare profession- als (HCPs) in hematopoietic stem cell transplantation (HSCT) centers were randomized to evaluate GvHD with or without a new electronic tool: the eGVHD application (eGVHD App). No App group, n=40; eGVHD App group, n=37. aGvHD: acute GvHD; cGvHD: chronic GvHD.
App compared to the No App group improved the num- ber of vignettes with a correct diagnosis [10/10 vs. 6.5/10, respectively; OR=6.14 (95%CI: 2.83-13.34; P<0.001)] as well as the number of vignettes with correct GvHD scor- ing [9/10 vs. 4.5/10, respectively; OR=6.29 (95%CI: 4.32- 9.15; P<0.001)]. Assessment of GvHD was significantly better in the App group for both acute (aGvHD) (OR=17.89; 95%CI: 8.47-37.79; P<0.001) and chronic (cGvHD) (OR=4.34; 95%CI: 2.79-6.74; P<0.001) GvHD. As shown in Figure 1, agreement between the HPCs' results and the Expert Gold Standard evaluations also showed the superiority of the use of the eGVHD App. For GvHD diagnosis, the No App group more often mis- diagnosed late acute and overlap chronic GvHD by con- sidering them as classic cGvHD. Scoring of aGvHD was frequently false in the No App group, in particular for grades II and IV, confused with cGvHD and grade III aGvHD, respectively. Scoring for cGvHD tended to be over-estimated (15%) or under-estimated (9%) by the App group without misclassification, while both diagno- sis and scoring were frequently erroneous in the No App group.
Agreement between HPCs was superior in the App group (0.73 vs. 0.56 in the No App group) independently
haematologica | 2018; 103(10)