Jacobsohn et al used a score to monitor patients with chronic graft-versus-host disease (GVHD). This can be used to monitor a patient's response to therapy of time. The authors are from Children's Memorial Hospital Chicago, the Johns Hopkins University and William Beaumont Hospital at Royal Oak, Michigan.
Patient selection: chronic GVHD
Assessment interval: every 3 months
Parameters:
(1) lichenoid/erythematous lesions in skin
(2) scleroderma-like changes in skin
(3) fascial changes
(4) mouth symptoms
(5) oral examination
(6) total serum bilirubin (as indicator of hepatic injury)
|
Parameter |
Finding |
Points |
|
lichenoid/erythematous skin |
none |
0 |
|
|
<= 25% of BSA |
1 |
|
|
25.1 to 50% of BSA |
2 |
|
|
50.1 to 75% BSA |
3 |
|
|
> 75% BSA |
4 |
|
scleroderma-like skin |
none (normal) |
0 |
|
|
thickened areas separated by normal skin |
1 |
|
|
majority of skin thickened |
2 |
|
|
thickened, unable to move |
3 |
|
|
hidebound, unable to pinch |
4 |
|
fascial changes |
normal |
0 |
|
|
tight with normal areas |
1 |
|
|
diffusely tight |
2 |
|
|
unable to move |
3 |
|
mouth symptoms |
none |
0 |
|
|
food sensitivity |
1 |
|
|
narcotics required for pain |
2 |
|
|
unable to eat |
3 |
|
oral examination |
normal |
0 |
|
|
erythema |
1 |
|
|
lichenoid areas |
2 |
|
|
ulcerations |
3 |
|
total serum bilirubin |
< 2 mg/dL |
0 |
|
|
2 to 5 mg/dL |
1 |
|
|
5.01 to 10 mg/dL |
2 |
|
|
10.01 to 15 mg/dL |
3 |
|
|
> 15 mg/dL |
4 |
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maxium score: 21
• The greater the score the worse the chronic GVHD.
• The number of items scored 3 or 4 can also be tracked.
Purpose: To evaluate a patient with chronic graft-versus-host disease (FVHD) using the clinical score of Jacobsohn et al.
Specialty: Immunology/Rheumatology
Objective: severity, prognosis, stage, response to therapy, disease progression
ICD-10: T86.0,
