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Published on: August 29, 2012
Methods to Assess Disease Activity and Severity in Cutaneous Chronic Graft-versus-Host Disease: A Critical Literature
Hadir Shakshouk1, Eric R Tkaczyk2, Edward W Cowen3
1Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Dermatology, Andrology and Venerology, Alexandria University, Alexandria, Egypt.
Insights
Assessing chronic graft-versus-host disease (cGVHD) severity is crucial but current methods for skin cGVHD are limited. Further research into objective markers like serologic and imaging technologies is needed.
Area of Science:
- Hematology
- Immunology
- Transplantation Medicine
Background:
- Chronic graft-versus-host disease (cGVHD) is a serious complication of hematopoietic cell transplantation, increasing mortality risk.
- Accurate assessment of cGVHD activity and severity is vital for treatment decisions.
- Current validated methods for assessing cutaneous cGVHD are limited.
Purpose of the Study:
- To identify and evaluate current data on assessing disease activity and severity in cutaneous cGVHD.
- To review the landscape of assessment methodologies for skin cGVHD.
Main Methods:
- A critical literature review was performed using modified PRISMA methods.
- 1741 articles were initially identified, with 106 included after screening.
- Included studies were categorized based on assessment parameters: clinical/histopathologic, serologic, imaging, and computer-based technologies.
Main Results:
- The National Institutes of Health consensus scoring system, based solely on clinical assessment, is the only formally validated metric for cutaneous cGVHD.
- A significant portion of studies focused on serologic parameters (50%), followed by clinical/histopathologic (37%).
- Imaging (7.5%) and computer-based technologies (5.5%) were less frequently addressed.
Conclusions:
- There is a critical need for objective markers in cGVHD assessment.
- Current validated assessment for cutaneous cGVHD relies on clinical evaluation alone.
- Further investigation into serologic, imaging, and computer-based technologies is warranted to improve cGVHD assessment.
Abstract:
Chronic graft-versus-host disease (cGVHD), a potentially debilitating complication of hematopoietic cell transplantation, confers increased risk for mortality. Whereas treatment decisions rely on an accurate assessment of disease activity/severity, validated methods of assessing cutaneous cGVHD activity/severity appear to be limited. In this study, we aimed to identify and evaluate current data on the assessment of disease activity/severity in cutaneous cGVHD. Using modified PRISMA methods, we performed a critical literature review for relevant articles. Our literature search identified 1741 articles, of which 1635 were excluded as duplicates or failure to meet inclusion criteria. Of the included studies (n = 106), 39 (37%) addressed clinical and/or histopathologic parameters, 53 (50%) addressed serologic parameters, 8 (7.5%) addressed imaging parameters, and 6 (5.5%) addressed computer-based technologies. The only formally validated metric of disease activity/severity assessment in cutaneous cGVHD is the National Institutes of Health consensus scoring system, which is founded on clinical assessment alone. The lack of an objective marker for cGVHD necessitates further studies. An evaluation of the potential contributions of serologic, imaging, and/or computer-based technologies is warranted.
