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Non-invasive measurement of sclerosis in cutaneous cGVHD patients with the handheld device Myoton: a cross-sectional study

Bone Marrow Transplantation volume 54, pages 616–619 (2019)Cite this article

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A Correction to this article was published on 17 January 2020

This article has been updated

Chronic graft-versus-host disease (cGVHD) is the leading cause of long-term mortality and morbidity after stem cell transplantation (SCT). Skin is the most commonly affected organ [1]. Skin manifestations of cGVHD are broadly divided into two categories: erythema and sclerosis. Among patients being treated for cGVHD, 20% develop sclerosis within 3 years of transplant, leading to significant disability [2]. The current standard for monitoring cGVHD sclerosis is the NIH Skin Score [3]. However, this scoring system is subjective, coarse, and unreliable [4]. Sclerosis measurement by exam is difficult due to ill-defined borders and paucity of reliable visible changes. Sclerosis scores among multiple observers rarely exhibit substantial agreement, with a minimal reliable change detection of 17–26% BSA [5]. This has impeded assessment of disease progression and treatment response [4]. Developing a quantitative and reproducible measurement of sclerosis was deemed a top priority in the 2014 NIH Consensus on Response Criteria for cGVHD [6]. Serial skin biopsy is not practical to assess treatment response and histology is generally non-specific [7]. This motivated interest in imaging tools for sclerotic cGVHD. A magnetic resonance imaging study of 15 cGVHD patients was able to identify abnormalities in the dermis, subcutaneous tissue, and muscle [8]. Ultrasound has shown differences in normalized shear wave speed in a study of four healthy controls versus five cGVHD patients [9]. Neither technology has yet advanced to large studies or widespread clinical use.

In this study, we investigated the feasibility of using an affordable tool to rapidly and directly measure cutaneous sclerosis in cGVHD patients. We employed the Myoton, a commercially available, non-invasive handheld device developed to measure muscle biomechanical properties. It has been applied in diverse fields [10], but has not yet been used in dermal disorders. It delivers a brief mechanical impulse to which tissue responds with a damped natural oscillation. Biomechanical properties are automatically extracted from the oscillatory response curve [11].

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  • 17 January 2020

    An amendment to this paper has been published and can be accessed via a link at the top of the paper.

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Acknowledgements

Dr. E.R.T. is grateful for support from NIH K12 CA090625. J.S.G was supported by the Vanderbilt Medical Scholars Program. This study is also supported in part by Career Development Award Number IK2 CX001785 from the United Sates Department of Veterans Affairs Clinical Science R&D (CSRD) Service and also by the Baltic-American Freedom Foundation.

Funding

NIH K12 CA090625, Baltic-American Freedom Foundation, VA CSRD CDA IK2 CX001785

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Authors and Affiliations

  1. Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA

    Fuyao Chen, Laura E. Dellalana, Arved Vain & Eric R. Tkaczyk

  2. Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA

    Fuyao Chen & Eric R. Tkaczyk

  3. Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Jocelyn S. Gandelman & Madan H. Jagasia

  4. Institute of Physics, University of Tartu, Tartu, Estonia

    Arved Vain

  5. Dermatology Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA

    Eric R. Tkaczyk

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  1. Fuyao Chen
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Correspondence to Eric R. Tkaczyk.

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Chen, F., Dellalana, L.E., Gandelman, J.S. et al. Non-invasive measurement of sclerosis in cutaneous cGVHD patients with the handheld device Myoton: a cross-sectional study. Bone Marrow Transplant 54, 616–619 (2019). https://doi.org/10.1038/s41409-018-0346-7

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