After bone marrow and stem cell transplantation, more than half of patients develop a specific condition known as Graft-versus-Host Disease (GVHD). During this process, donor immune cells recognize the patient’s body as foreign and attack its tissues, primarily the skin. The course of chronic cutaneous GVHD is not limited solely to dermatological manifestations; it causes tissue hardening, pain, and restricted movement.
Until now, existing evaluation methods were often subjective and did not accurately reflect the effectiveness of treatment. In response to this challenge, the NIH 2024-2025 Working Group presented a fundamental update to the disease evaluation systems.
Currently functioning evaluation systems contain several critical flaws, manifested primarily in the subjectivity of diagnosis. Different specialists often assign different scores to the same patient. Added to this is the coarse gradation of existing Body Surface Area (BSA) categories, which makes it impossible to record small but clinically significant improvements for the patient.
Another shortcoming of the system represents the inability to differentiate disease phenotypes. The protocol cannot distinguish active inflammatory processes from already established fibrous lesions, which, in turn, leads to the selection of inappropriate treatment tactics. Furthermore, in terms of ethnic inclusivity, the identification of erythema on dark skin remains a problem. This difficulty significantly increases the risk of diagnostic error.
The 2025 Update
The new methodological approach is based on the strict differentiation of pathological processes. First and foremost, disease phenotypes have been separated, which implies the independent evaluation of the Body Surface Area (BSA)occupied by epidermal (erythematous) and sclerotic components.
Clinical parameters such as edema, active inflammation, and specific ulcerative lesions were added to the sclerosis evaluation protocol, while the degree of joint mobility was separated into an independent scale. In addition, innovative measures were introduced into diagnostic practice: the SQPS system for the objective evaluation of skin rigidity and softness, and the SDFI index to determine the impact of the disease on the patient’s daily functional capabilities.
The Role of the Patient and Technological Progress
A significant innovation in the modern protocol represents the prioritization of the Lee Symptom Scale (LSS). Clinical practice has confirmed that itchiness and skin rigidity subjectively perceived by the patient reflect disease dynamics much earlier and more accurately than medical evaluation. Simultaneously, high-tech methods are being implemented in the diagnostic process.
To determine skin stiffness, an objective Myoton device is used. Magnetic Resonance Imaging (MRI) and Artificial Intelligence (AI) algorithms allow for the visualization of deep fibrous changes and the automatic calculation of the affected area. From a prognostic standpoint, decisive importance is assigned to the identification of specific biomarkers (e.g., DKK3, BAFF), which ensures the prediction of the disease course based on the analysis of the protein profile in blood plasma.
Thus, the optimization of evaluation systems is directly proportional to the quality of treatment. The implementation of more accurate criteria accelerates the process of authorization for new medications by the FDA and ensures the selection of individual, targeted therapy for each patient. It is expected that in the next 3–5 years, these changes will significantly reduce the risk of post-transplantation complications.
Source: Transplantation and Cellular Therapy
