{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:13:22Z","timestamp":1788412402139,"version":"build-2803163510"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2023,4,1]]},"abstract":"<jats:sec id=\"ab-doi220075-4\"><jats:title>Importance<\/jats:title><jats:p>Prior studies have demonstrated an association between cutaneous chronic graft-vs-host disease (cGVHD) and mortality. Assessment of the prognostic value of different measures of disease severity would assist in risk stratification.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi220075-5\"><jats:title>Objective<\/jats:title><jats:p>To compare the prognostic value of body surface area (BSA) and National Institutes of Health (NIH) Skin Score on survival outcomes stratified by erythema and sclerosis subtypes of cGVHD.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi220075-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>Multicenter prospective cohort study from the Chronic Graft-vs-Host Disease Consortium including 9 medical centers in the US, enrolled from 2007 through 2012 and followed until 2018. Participants were adults and children with a diagnosis of cGVHD requiring systemic immunosuppression and with skin involvement during the study period, who had longitudinal follow-up. Data analysis was performed from April 2019 to April 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi220075-7\"><jats:title>Exposures<\/jats:title><jats:p>Patients underwent continuous BSA estimation and categorical NIH Skin Score grading of cutaneous cGVHD at enrollment and every 3 to 6 months thereafter.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi220075-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Nonrelapse mortality (NRM) and overall survival (OS), compared between BSA and NIH Skin Score longitudinal prognostic models, adjusted for age, race, conditioning intensity, patient sex, and donor sex.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi220075-9\"><jats:title>Results<\/jats:title><jats:p>Of 469 patients with cGVHD, 267 (57%) (105 female [39%]; mean [SD] age, 51 [12] years) had cutaneous cGVHD at enrollment, and 89 (19%) developed skin involvement subsequently. Erythema-type disease had earlier onset and was more responsive to treatment compared with sclerosis-type disease. Most cases (77 of 112 [69%]) of sclerotic disease occurred without prior erythema. Erythema-type cGVHD at first follow-up visit was associated with NRM (hazard ratio, 1.33 per 10% BSA increase; 95% CI, 1.19-1.48; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and OS (hazard ratio, 1.28 per 10% BSA increase; 95% CI, 1.14-1.44; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), while sclerosis-type cGVHD had no significant association with mortality. The model with erythema BSA collected at baseline and first follow-up visits retained 75% of the total prognostic information (from all covariates including BSA and NIH Skin Score) for NRM and 73% for OS, with no statistical difference between prognostic models (likelihood ratio test \u03c7<jats:sup>2<\/jats:sup>, 5.9; <jats:italic>P<\/jats:italic>\u2009=\u2009.05). Conversely, NIH Skin Score collected at the same intervals lost significant prognostic information (likelihood ratio test \u03c7<jats:sup>2<\/jats:sup>, 14.7; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). The model incorporating NIH Skin Score instead of erythema BSA accounted for only 38% of the total information for NRM and 58% for OS.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi220075-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this prospective cohort study, erythema-type cutaneous cGVHD was associated with increased risk of mortality. Erythema BSA collected at baseline and follow-up predicted survival more accurately than the NIH Skin Score in patients requiring immunosuppression. Accurate assessment of erythema BSA may assist in identifying patients with cutaneous cGVHD at high risk for mortality.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2022.6624","type":"journal-article","created":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T16:09:27Z","timestamp":1678291767000},"page":"393","source":"Crossref","is-referenced-by-count":22,"title":["Prognostic Value of Cutaneous Disease Severity Estimates on Survival Outcomes in Patients With Chronic Graft-vs-Host Disease"],"prefix":"10.1001","volume":"159","author":[{"given":"Emily","family":"Baumrin","sequence":"first","affiliation":[{"name":"Department of Dermatology, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura X.","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Byrne","sequence":"additional","affiliation":[{"name":"Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Martin","sequence":"additional","affiliation":[{"name":"Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington"},{"name":"Department of Medicine, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Flowers","sequence":"additional","affiliation":[{"name":"Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington"},{"name":"Department of Medicine, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn","family":"Onstad","sequence":"additional","affiliation":[{"name":"Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najla","family":"El Jurdi","sequence":"additional","affiliation":[{"name":"Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Beeghly-Fadiel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington"},{"name":"Department of Medicine, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric R.","family":"Tkaczyk","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs, Nashville, Tennessee"},{"name":"Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"doi220075r1","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1056\/NEJM199907013410103","article-title":"Long-term survival and late deaths after allogeneic bone marrow transplantation.","volume":"341","author":"Soci\u00e9","year":"1999","journal-title":"N Engl J Med"},{"issue":"2","key":"doi220075r2","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1182\/blood.V100.2.406","article-title":"Severity of chronic graft-versus-host disease: association with treatment-related mortality and 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