Development and Validation of a Symptom Scale for Children With Chronic Graft-versus-Host Disease

Background:

• Currently, a large number of children with chronic GVHD have to deal with many years of a disfiguring and painful chronic illness with the side effects of long term steroid use.
• The broad categories of limited and extensive chronic GVHD are recognized by clinicians, but are not particularly useful in clinical practice. Chronic GVHD may involve almost every organ although it most commonly affects skin, eyes, mouth, liver, intestines, lung and musculoskeletal system.
• Recently, there has been a large effort through the NIH Consensus for chronic GVHD to standardize response criteria for patients with chronic GVHD, on clinical trials. Because of the absence of evidence suggesting which response criteria truly correlates with improvement, the NIH Consensus Panel has recommended following not only physical signs of chronic GVHD, but also symptoms of GVHD.

Primary Objective:

- Develop a Pediatric Chronic GVHD Symptom Scale (PCSS) that reliably measures the disease specific burden of chronic GVHD in children.

Secondary Objectives:

• Correlate high and low scores on the PCSS with standard quality of life measures.
• Determine using the Rasch measurement model whether the PCSS has sufficient sensitivity to change for the scale to be useful in clinical intervention trials.

Eligibility:

• Children of 5 to 18 years of age, who have undergone prior allogeneic stem cell transplant
• Clinical diagnosis of chronic GVHD with need for systemic treatment
• No evidence of primary disease relapse
• Must be willing to sign informed consent, or if applicable, child assent

Design:

• With the final goal of developing a scale that is similar in design to the Lee Scale but which measures the symptom burden more specifically for children with chronic GVHD, the study will be conducted in two phases: item generation and psychometric validation.
• In phase I, the local team at each institution will interview participants using a script to identify symptom concerns for pediatric chronic GVHD patients. Based on interviews, we will decide whether to test different scales for the different age groups, or a single scale for all.
• Data from Phase II will be used to finalize and validate the pediatric symptom scale, through the assessment of test-retest characteristics, use of item reduction, examination of construct validity, internal consistency, convergent and divergent validity, and evaluation of sensitivity to change.