Archives of Physical Medicine and Rehabilitation

2021

DOI: 10.1016/j.apmr.2020.10.141

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Rehabilitation Interventions in the Multidisciplinary Management of Patients With Sclerotic Graft-Versus-Host Disease of the Skin and Fascia

Paula Móles‐Poveda

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Chronic Gvhd2

V122 Fascial2

Benefits Of Incorporating Pros In Cutaneous Cgvhd Trials And...1

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Cited by 9 publications

(6 citation statements)

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“…Including PROs may be particularly important in evaluating patients with skin sclerosis, since identifying active disease can be challenging for this condition. As well, a more precise understanding of symptom burden and functional impairment can help dermatologists monitor progress and recommend timely referrals for supportive, palliative, and rehabilitation care, including rehabilitative techniques, home exercises, or alternative symptom relief modalities …”

Section: Benefits Of Incorporating Pros In Cutaneous Cgvhd Trials And...mentioning

confidence: 99%

Improving Outcomes in Chronic Graft-vs-Host Disease

Mitchell,

Cowen

2024

JAMA Dermatol

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Chronic graft-vs-host disease (cGVHD) is a frequent, heterogeneous, and often life-threatening complication of allogeneic hematopoietic stem cell transplantation. A total of 25% to 50% of all transplant survivors develop cGVHD, and cutaneous manifestations are seen in approximately 75% of these patients. 1 Cutaneous manifestations of cGVHD include skin fibrosis (sclerotic cGVHD), epidermal involvement resembling lichen planus, or a combination of both findings. Alopecia, genital inflammation/ scarring, nail dystrophy, pigmentary changes, ulceration, and poor wound healing are additional features. Associated skin changes range from mild and self-limited to severe, highly distressing, disfiguring, and permanently disabling disease. 2 Treatment of cGVHD is challenging due to the multiorgan nature of the disease, which may include eyes, lungs, liver, muscles/fascia, and gastrointestinal involvement, as well as difficulties assessing disease activity and treatment response.In this issue of JAMA Dermatology, rather than propose another instrument to quantify the extent of cGVHD-related skin disease, Baumrin and colleagues 3 used 2 well-validated patientreported outcome (PRO) measures, the Lee cGVHD Symptom Scale and the Functional Assessment of Cancer Treatment-BMT, to explore the association of these PROs with survival in patients with cutaneous cGVHD. PROs, including selfreported measures of symptom burden, functional status, and health-related quality of life (HRQL), provide valuable insights in understanding the humanistic burden of disease, are associated with improved risk and prognostic stratification, and gauge therapeutic response and tolerability of treatment. [4][5][6] PROs can also be applied in clinical care to identify unmet needs, improve patient-clinician communication, and target services to patients at greatest risk to experience unfavorable outcomes. 7 Multiple PRO measures are available to capture symptom burden, functional status, HRQL, and mental health as well as to evaluate organ-specific issues, such as pruritus, shortness of breath, or nutritional impairment. Both PRO instruments used by Baumrin et al 3 have demonstrated sensitivity to detect multidimensional effects of cutaneous cGVHD. 6 In their multicenter, prospective, longitudinal cohort study, Baumrin et al 3 compared patients with sclerotic and combination-type (epidermal and sclerotic) cutaneous cGVHD over time with those with epidermal disease only in covariateadjusted models. Baumrin et al 3 demonstrated that compared with those with epidermal disease, patients with sclerotic and combination-type cutaneous cGVHD experienced statistically significant and clinically meaningful declines in HRQL and higher levels of skin-related symptom burden (eg, abnormal color, rash, thickening, sores, and itching). More-

“…Including PROs may be particularly important in evaluating patients with skin sclerosis, since identifying active disease can be challenging for this condition. As well, a more precise understanding of symptom burden and functional impairment can help dermatologists monitor progress and recommend timely referrals for supportive, palliative, and rehabilitation care, including rehabilitative techniques, home exercises, or alternative symptom relief modalities …”

Section: Benefits Of Incorporating Pros In Cutaneous Cgvhd Trials And...mentioning

confidence: 99%

Improving Outcomes in Chronic Graft-vs-Host Disease

Mitchell,

Cowen

2024

JAMA Dermatol

Self Cite

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Chronic graft-vs-host disease (cGVHD) is a frequent, heterogeneous, and often life-threatening complication of allogeneic hematopoietic stem cell transplantation. A total of 25% to 50% of all transplant survivors develop cGVHD, and cutaneous manifestations are seen in approximately 75% of these patients. 1 Cutaneous manifestations of cGVHD include skin fibrosis (sclerotic cGVHD), epidermal involvement resembling lichen planus, or a combination of both findings. Alopecia, genital inflammation/ scarring, nail dystrophy, pigmentary changes, ulceration, and poor wound healing are additional features. Associated skin changes range from mild and self-limited to severe, highly distressing, disfiguring, and permanently disabling disease. 2 Treatment of cGVHD is challenging due to the multiorgan nature of the disease, which may include eyes, lungs, liver, muscles/fascia, and gastrointestinal involvement, as well as difficulties assessing disease activity and treatment response.In this issue of JAMA Dermatology, rather than propose another instrument to quantify the extent of cGVHD-related skin disease, Baumrin and colleagues 3 used 2 well-validated patientreported outcome (PRO) measures, the Lee cGVHD Symptom Scale and the Functional Assessment of Cancer Treatment-BMT, to explore the association of these PROs with survival in patients with cutaneous cGVHD. PROs, including selfreported measures of symptom burden, functional status, and health-related quality of life (HRQL), provide valuable insights in understanding the humanistic burden of disease, are associated with improved risk and prognostic stratification, and gauge therapeutic response and tolerability of treatment. [4][5][6] PROs can also be applied in clinical care to identify unmet needs, improve patient-clinician communication, and target services to patients at greatest risk to experience unfavorable outcomes. 7 Multiple PRO measures are available to capture symptom burden, functional status, HRQL, and mental health as well as to evaluate organ-specific issues, such as pruritus, shortness of breath, or nutritional impairment. Both PRO instruments used by Baumrin et al 3 have demonstrated sensitivity to detect multidimensional effects of cutaneous cGVHD. 6 In their multicenter, prospective, longitudinal cohort study, Baumrin et al 3 compared patients with sclerotic and combination-type (epidermal and sclerotic) cutaneous cGVHD over time with those with epidermal disease only in covariateadjusted models. Baumrin et al 3 demonstrated that compared with those with epidermal disease, patients with sclerotic and combination-type cutaneous cGVHD experienced statistically significant and clinically meaningful declines in HRQL and higher levels of skin-related symptom burden (eg, abnormal color, rash, thickening, sores, and itching). More-

“…Imatinib targets the PDGFR and TGF-b pathways which are involved in skin fibrosis. Besides pharmaceutic interventions, physiotherapy is one of the most useful adjunctive treatments in patients with fasciitis or contractures due to sclerodermiformic GvHD and should always be part of a comprehensive treatment approach (39).…”

Section: Chronic Gvhdmentioning

confidence: 99%

Established and Emerging Treatments of Skin GvHD

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²

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³

2022

Front. Immunol.

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Graft-versus-host disease (GvHD) of the skin is a severe allo-immune reaction and complication following allogeneic stem cell transplantation. Over the past years, intensive pre-clinical research has led to an improved understanding of the pathophysiology of acute and to a lesser extend chronic GvHD. This has translated into the approval of several new agents for the treatment of both forms of GvHD. This review summarizes the most recent advances in underlying pathomechanisms, clinical trials and newly approved agents for GvHD, with a special focus on skin involvement.

“…Such physical limitations affect the younger patient going to work, as well as older retired patients, and these impairments should be handled intensively [ 57 ]. To achieve this goal, the physiotherapist should possess a great deal of experience in treating this alloHCT complication in particular, especially in patients suffering from skin/fascia-related GvHDs [ 58 ]. A list of possible interventions is listed in Table 8 .…”

Section: Rehabilitation With Chronic Gvhdmentioning

confidence: 99%

Rehabilitation after Allogeneic Haematopoietic Stem Cell Transplantation: A Special Challenge

¹

2021

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The general population is getting older and suffer more haematological malignancies despite being physically fit. These malignancies are mainly only curable via an alloHCT, and they are now carried out more frequently. Patients benefit from intensive rehabilitation earlier and may need it repeatedly in cases of severe side effects (e.g., graft-versus-host disease). They can suffer many problems that other cancer patients do not experience, such as severe infections, continued immunosuppression, nutritional restrictions, acute or chronic GvHD, or organ impairments (e.g., lung, eyes). They may also encounter various associated psychological problems, e.g., feeling like a chimera. Rehabilitation centres willing to care for patients after alloHCT should have an experienced multidisciplinary team and should work in close co-operation with the primary transplant centre.

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