BSA Superior to NIH Skin Scores in Prognosis of Erythema-Type Chronic Graft-Versus-Host Disease


A new study indicated that body surface area predicted erythema-type chronic graft-vs-host disease survival more accurately than NIH Skin Scores.

Erythema-type chronic graft-vs-host disease (cGVHD) is a valuable clinical prognostic marker, maintaining more value when determined through a body surface area (BSA) assessment, new findings show.

These findings were the result of a study comparing prognostic value of BSA assessments and National Institutes of Health (NIH) Skin scores for survival outcomes of cGVHD.

This research was authored by Eric R. Tkaczyk, MD, PhD, from the Department of Dermatology at the Vanderbilt University Medical Center in Tennessee.

“Prior studies have demonstrated an association of cutaneous cGVHD activity with survival outcomes,” Tkaczyk and colleagues wrote. “Higher 2005 NIH Skin Score was associated with worse survival in a cohort of patients with cutaneous cGVHD…Here, we compare the prognostic value of erythema BSA and 2005 NIH Skin Score to identify the most informative assessments for clinical practice and therapeutic trials.”

Background and Findings

The investigators conducted a multicenter, cohort study through the Chronic Graft-vs-Host Disease Consortium in the period between 2007 and 2012, which was located in 9 medical centers in the US.

They recruited adults and children who had been diagnosed with cGVHD and showed a need for systemic immunosuppression with skin involvement at the same time as the study. The researchers also had longitudinal follow-up meetings up until 2018.

At enrollment of the participants, and every 3 to 6 months thereafter, the investigators assessed continuous BSA estimation and categorical NIH Skin Score grading of participants’ cutaneous cGVHD. Their data analysis was done from 2019 to 2022.

The investigators’ primary outcomes for their study were non-relapse mortality (NRM) and overall survival (OS), which were compared between the BSA and NIH Skin Score longitudinal prognostic models.

Overall, the investigators concluded that, of the 469 participants with cGVHD, 57% of them reported cutaneous cGVHD at their enrollment and 19% of participants ended up developing skin involvement subsequently. The investigators found that the erythema-type group showed earlier onset times and better responses to treatment than those of the sclerosis-type. Most cases of sclerotic disease occurred without prior erythema.

The research team added that erythema-type cGVHD at the initial follow-up meetings had an association with OS and NRM, whereas sclerosis-type showed no significant association with mortality.

“In this prospective cohort study, erythema-type cutaneous cGVHD was associated with increased risk of mortality,” they wrote. “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.”


Baumrin E, Baker LX, Byrne M, et al. Prognostic Value of Cutaneous Disease Severity Estimates on Survival Outcomes in Patients With Chronic Graft-vs-Host Disease. JAMA Dermatol. Published online March 08, 2023. doi:10.1001/jamadermatol.2022.6624.

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