Division of Blood and Marrow Transplantation, Children's National Medical Center, Washington, DC, USA.
Blood. 2012 Sep 27;120(13):2545-52; quiz 2774. doi: 10.1182/blood-2012-04-424135. Epub 2012 Jul 6.
There are no validated criteria to measure skin response in chronic GVHD. In a prospectively assembled, multicenter cohort of patients with chronic GVHD (N = 458), we looked for correlation of change in several different scales recommended by the National Institutes of Health (NIH) Consensus with clinician and patient perception of change and overall survival. Of the clinician scales, the NIH composite 0-3 skin score was the only one that correlated with both clinician and patient perception of improvement or worsening. Of the patient-reported scales, the skin subscale of the Lee Symptom Scale was the only one that correlated with both clinician and patient perception of improvement or worsening. At study entry, NIH skin score 3 and Lee skin symptom score > 15 were both associated with worse overall survival. Worsening of NIH skin score at 6 months was associated with worse overall survival. Improvement in the Lee skin symptom score at 6 months was associated with improved overall survival. Our findings support the use of the NIH composite 0-3 skin score and the Lee skin symptom score as simple and sensitive measures to evaluate skin involvement in clinical trials as well as in the clinical monitoring of patients with cutaneous chronic GVHD.
目前尚无用于评估慢性移植物抗宿主病皮肤反应的验证标准。在一项前瞻性的、多中心的慢性移植物抗宿主病患者队列研究（N=458）中，我们研究了美国国立卫生研究院（NIH）共识推荐的几种不同量表的变化与临床医生和患者对疾病变化的感知以及总生存的相关性。在临床医生评估量表中，NIH 综合 0-3 皮肤评分与临床医生和患者对改善或恶化的感知均相关。在患者报告量表中，Lee 症状量表的皮肤子量表与临床医生和患者对改善或恶化的感知均相关。在研究入组时，NIH 皮肤评分 3 分和 Lee 皮肤症状评分>15 均与总生存较差相关。6 个月时 NIH 皮肤评分恶化与总生存较差相关。6 个月时 Lee 皮肤症状评分改善与总生存改善相关。我们的研究结果支持使用 NIH 综合 0-3 皮肤评分和 Lee 皮肤症状评分作为评估临床试验以及皮肤慢性移植物抗宿主病患者临床监测中皮肤受累的简单、敏感的指标。
