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RecruitingNCT00092235Updated Sep 22, 2026

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

An observational study in Chronic Graft vs. Host Disease, sponsored by National Cancer Institute (NCI). Recruiting at 1 site in United States. Open to participants aged 1 Year to 120 Years. Per ClinicalTrials.gov, last updated 2026-09-22.

Sponsored by National Cancer Institute (NCI) · Observational

From the registry’s dates

  • Started Oct 2004; still recruiting 21 years 11 months later.
Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
650
Ages
1 Year to 120 Years
Sex
All
01

Study summary

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 the 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 multispecialty 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 tem data collection for evaluation of long-term outcomes will be conducted anually as feasible
Read the detailed description

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.
02

Conditions studied

  • Chronic Graft vs. Host Disease

Keywords

  • cGVHD-associated graft-versus-tumor effects (GVT)
  • Allo-HSCT controls
  • Leukapheresis
  • Natural History
03

In context

Lead sponsor

National Cancer Institute (NCI) is the lead sponsor of 3,506 studies on the registry; 334 are open to participants now.

Of its 402 completed or terminated interventional studies of FDA-regulated products, 365 (91%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
1 Year to 120 Years
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

Patients will be selected via referrals or from patients who were on companion clinical protocols at the NIH.

Inclusion criteria

  1. 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

    1. Patient or the patient's legal representative is able and willing to provide consent.

Exclusion criteria

EXCLUSION CRITERIA:

  1. 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
  2. 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.

  3. 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
05

Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
650 participants (estimated)

Groups and cohorts

  • Cohort 1

    Patients who have undergone an allogeneic stem cell transplant and are diagnosed with cGVHD

  • Cohort 2

    Pediatric patients who have undergone an allogeneic stem cell transplant and are diagnosed with cGVHD

  • Cohort 3

    Patients who have undergone an allogeneic stem cell transplant and choose to submit biopsy, blood and urine samples only

  • Cohort 4

    Patients who have undergone an allogeneic stem cell transplant and are not diagnosed with cGVHD

06

What researchers measure

Primary outcomes

  1. To prospectively identify candidate markers for clinical and biological prognostic factors in patients with cGVHD and develop a prognostic model

    Patient evaluations resulting in collection of data via several medical specialties; data will be examined individually and against clinical outcomes.

    Time frame: 2 years + 3 months after protocol entry

  2. To improve our current understanding of the biology of cGVHD-associated graft-versus-tumor effects (GVT).

    Studying mechanisms of how cGVHD exerts its anti-cancer effects via laboratory analysis.

    Time frame: ongoing

  3. To identify potential clinical and biological markers of cGVHD activity

    Assessment of risk and outcome as related to molecular markers of pathogenesis and/or stage of disease.

    Time frame: ongoing

  4. To identify novel biological characteristics of cGVHD and to describe them in the context of clinical history and presentation

    Through collection of data via several medical specialties, assess the weight of specific clinical and biological characteristics and disease severity scales for predicting major clinical outcomes.

    Time frame: ongoing

  5. To establish a multidisciplinary clinic infrastructure for study of pathogenesis and natural history of cGVHD

    Assessment of clinical and biological characteristics of cGVHD.

    Time frame: ongoing

  6. To develop clinically relevant cGVHD grading scales

    Develop appropriate staging as a tool for measuring responses or outcomes in clinical studies through prospective collection and analysis of data.

    Time frame: ongoing

07

Study locations

1 of 1 sites recruiting
  • National Institutes of Health Clinical Center
    Bethesda, Maryland 20892, United States
    Recruiting
08

References and documents

Publications

  • Zhao AT, Pirsl F, Steinberg SM, Holtzman NG, Schulz E, Mina A, Mays JW, Cowen EW, Comis LE, Joe GO, Yanovski JA, Pavletic SZ. Metabolic syndrome prevalence and impact on outcomes in patients with chronic graft-versus-host disease. Bone Marrow Transplant. 2023 Dec;58(12):1377-1383. doi: 10.1038/s41409-023-02097-y. Epub 2023 Sep 8. PubMed 37684526 ↗
  • Schulz E, Pirsl F, Holtzman NG, Beshensky D, Cowen EW, Mitchell SA, Steinberg SM, Pavletic SZ. Red cell distribution width as a new prognostic biomarker in refractory chronic graft-versus-host disease. Haematologica. 2024 Jan 1;109(1):298-302. doi: 10.3324/haematol.2023.283646. No abstract available. PubMed 37584292 ↗
  • Beshensky D, Pirsl F, Holtzman NG, Steinberg SM, Mays JW, Cowen EW, Comis LE, Joe GO, Magone MT, Schulz E, Waldman MA, Pavletic SZ. Predictors and significance of kidney dysfunction in patients with chronic graft-versus-host disease. Bone Marrow Transplant. 2023 Oct;58(10):1112-1120. doi: 10.1038/s41409-023-02032-1. Epub 2023 Jul 20. PubMed 37474729 ↗
  • Yang AH, Han MAT, Samala N, Rizvi BS, Marchalik R, Etzion O, Wright EC, Cao L, Hakim FT, Jones E, Kapuria D, Hickstein DD, Fowler D, Kanakry JA, Kanakry CG, Kleiner DE, Koh C, Pavletic SZ, Heller T. Characterization of Hepatic Dysfunction in Subjects Diagnosed With Chronic GVHD by NIH Consensus Criteria. Transplant Cell Ther. 2022 Nov;28(11):747.e1-747.e10. doi: 10.1016/j.jtct.2022.07.017. Epub 2022 Jul 22. PubMed 35878742 ↗
  • Ruben CL, Pirsl F, Steinberg SM, Holtzman NG, Parsons-Wandell L, Baruffaldi J, Curtis LM, Mitchell SA, Kerep AZ, Cowen EW, Berger A, Joe GO, Datiles MB 3rd, Mays JW, Pavletic SZ. Predictors of hematologic malignancy relapse in patients with advanced chronic graft-versus-host disease. Bone Marrow Transplant. 2021 Jul;56(7):1584-1592. doi: 10.1038/s41409-021-01211-2. Epub 2021 Feb 1. PubMed 33526918 ↗
  • Katic M, Pirsl F, Steinberg SM, Dobbin M, Curtis LM, Pulanic D, Desnica L, Titarenko I, Pavletic SZ. Vitamin D levels and their associations with survival and major disease outcomes in a large cohort of patients with chronic graft-vs-host disease. Croat Med J. 2016 Jun 30;57(3):276-86. doi: 10.3325/cmj.2016.57.276. PubMed 27374829 ↗
  • Curtis LM, Datiles MB 3rd, Steinberg SM, Mitchell SA, Bishop RJ, Cowen EW, Mays J, McCarty JM, Kuzmina Z, Pirsl F, Fowler DH, Gress RE, Pavletic SZ. Predictive models for ocular chronic graft-versus-host disease diagnosis and disease activity in transplant clinical practice. Haematologica. 2015 Sep;100(9):1228-36. doi: 10.3324/haematol.2015.124131. Epub 2015 Jun 18. PubMed 26088932 ↗
  • Bassim CW, Fassil H, Dobbin M, Steinberg SM, Baird K, Cole K, Joe G, Comis LE, Mitchell SA, Grkovic L, Edwards D, Mays JW, Cowen EW, Pulanic D, Williams KM, Gress RE, Pavletic SZ. Malnutrition in patients with chronic GVHD. Bone Marrow Transplant. 2014 Oct;49(10):1300-6. doi: 10.1038/bmt.2014.145. Epub 2014 Jul 14. PubMed 25029231 ↗
  • Martires KJ, Baird K, Steinberg SM, Grkovic L, Joe GO, Williams KM, Mitchell SA, Datiles M, Hakim FT, Pavletic SZ, Cowen EW. Sclerotic-type chronic GVHD of the skin: clinical risk factors, laboratory markers, and burden of disease. Blood. 2011 Oct 13;118(15):4250-7. doi: 10.1182/blood-2011-04-350249. Epub 2011 Jul 26. PubMed 21791415 ↗
  • Clark J, Yao L, Pavletic SZ, Krumlauf M, Mitchell S, Turner ML, Cowen EW. Magnetic resonance imaging in sclerotic-type chronic graft-vs-host disease. Arch Dermatol. 2009 Aug;145(8):918-22. doi: 10.1001/archdermatol.2009.78. PubMed 19687424 ↗
  • Imanguli MM, Swaim WD, League SC, Gress RE, Pavletic SZ, Hakim FT. Increased T-bet+ cytotoxic effectors and type I interferon-mediated processes in chronic graft-versus-host disease of the oral mucosa. Blood. 2009 Apr 9;113(15):3620-30. doi: 10.1182/blood-2008-07-168351. Epub 2009 Jan 23. PubMed 19168793 ↗

Individual participant data

Plan to share: Yes — All IPD recorded in the medical record will be shared with intramural investigators upon request. @@@@@@@@@@@@In addition, all large scale genomic sequencing data will be shared with subscribers to dbGaP.

Supporting information: Study protocol, Sap, Icf

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Sep 22, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT00092235
Lead sponsor
National Cancer Institute (NCI)
Collaborators
Emory University, Department of Pediatrics
Responsible party
Sponsor
First posted
Sep 22, 2004
Start date
Oct 26, 2004
Last update
Sep 22, 2026

Study contacts

Najla El Jurdi, M.D.
Contact
najla.eljurdi@nih.gov
(240) 992-4033
Najla El Jurdi, M.D.
principal investigator · National Cancer Institute (NCI)

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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