The following is a summary of “Patient-Reported Outcomes and Mortality in Cutaneous Chronic Graft-vs-Host Disease,” published in the February 2024 issue of Dermatology by Baumrin, et al.
For a study, researchers sought to investigate the link between various types of chronic graft-vs-host disease (GVHD) and patient-reported outcomes (PROs) over time and to assess whether PROs could serve as predictors of mortality risk in patients with cutaneous chronic GVHD.
The prospective cohort study involved patients from the Chronic GVHD Consortium, spanning 9 medical centers across the United States. Enrollment occurred between August 2007 and April 2012, with follow-up continuing until December 2020. The participants comprised adults aged 18 years and older who were diagnosed with chronic GVHD requiring systemic immunosuppression and had skin involvement during the study period. The primary outcomes and measures included the assessment of patient-reported symptom burden using the Lee Symptom Scale (LSS) skin subscale, where higher scores indicated worse outcomes. Additionally, quality of life was evaluated using the Functional Assessment of Cancer Therapy–Bone Marrow Transplantation (FACT-BMT) instrument, with lower scores indicating poorer outcomes. The study also examined nonrelapse mortality and overall survival and their association with patient-reported outcomes (PROs) at the time of diagnosis.
About 36 patients diagnosed with cutaneous chronic GVHD, with a median age at transplant of 51 years (interquartile range [IQR]: 41.5-56.6) and 261 (59.9%) being male, the distribution of chronic GVHD types was as follows: 229 patients (52.5%) had epidermal-type chronic GVHD, 131 (30.0%) had sclerotic chronic GVHD, and 76 (17.4%) had a acombination of both. After accounting for potential confounding factors, patients with sclerotic chronic GVHD had a mean FACT-BMT score 6.1 points lower than those with epidermal disease (95% CI, 11.7 to 0.4; P = .04). Similarly, patients with combination disease had a mean LSS skin subscale score 9.0 points lower than those with epidermal disease (95% CI, 4.2 to 13.8; P < .001). Clinically significant differences were defined as a decrease of at least 7 points for FACT-BMT and an increase of 11 points for the LSS skin subscale. At diagnosis, clinically substantial worsening in FACT-BMT score was associated with a 9.1% increase in adjusted odds of nonrelapse mortality (95% CI, 2.0% to 16.7%; P = .01). Similarly, a clinically significant worsening in LSS skin subscale score was associated with a 16.4% increase in adjusted odds of nonrelapse mortality (95% CI, 5.4% to 28.5%; P = .003). These associations remained significant even after adjusting for clinical severity using the National Institutes of Health Skin Score.
Associations remained significant even after adjusting for clinical severity.
In conclusion, chronic GVHD affecting the skin was found to be independently associated with long-term impairment in PROs, with sclerotic and combination diseases having the most significant impact. Notably, the degree of impairment at the time of diagnosis was identified as a prognostic marker for mortality. Thus, monitoring PROs could aid in risk stratification and treatment selection for patients with chronic GVHD.
Reference: jamanetwork.com/journals/jamadermatology/article-abstract/2815574