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SWAT assessment tool

The Severity-weighted assessment tool (SWAT) used in the ZOLINZA pivotal trial is an objective, quantitative, severity-weighted method to assess the extent of CTCL lesions. A SWAT score is derived by measuring each lesion as a percentage of total body surface area (%TBSA) and multiplying it by a severity-weighting factor (1=patch, 2=plaque, 4=tumor). All individual numbers are then added to produce a total score. Among the patients in this trial, the median baseline SWAT score was 73.7 (range: 1.5–366.0).

SWAT methodology

Quantitative Tool to Assess Disease Burden in CTCL1
The body is divided into 12 regions with preassigned %TBSA based on methodology used to assess burns as shown in the figure below. The extent of skin disease is assessed for each region and quantified by using the patient's palm as a "ruler" to measure the %TBSA involvement within each region:

  • Patient's palm with 4 fingers, excluding the thumb and measured from wrist to fingertips, is 1% of TBSA.
  • Patient's palm without fingers is 0.5% of TBSA.
SWAT
% Total Body Surface Area (TBSA) for 12 Main Body Areas2
SWAT
References: 1. Stevens SR, Ke MS, Parry EJ, Mark J, Cooper KD. Quantifying skin disease burden in mycosis fungoides–type cutaneous T-cell lymphomas. Arch Dermatol. 2002;138:42–48. 2. Lund CC, Browder NC. The estimation of areas of burns. Surg Gynecol Obstet. 1944;79:352–358.

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Modified SWAT assessment tool

Area of skin involvement identified as patch, plaque, or tumor as defined in the table below:

Skin Lesion Definitions
Lesion Type Abnormal Skin Erythema
Patch Abnormal skin not elevated from normal skin Flat erythema or erythema with mild infiltration
Plaque Abnormal skin elevated from normal skin by <5 mm Elevated erythema or erythema with moderate infiltration
Tumor Abnormal skin elevated from normal skin by ≥5 mm Erythema with fissuring, ulceration, or tumor
SWAT Score Calculation
Sum of %TBSA from all body regions affected by patches x severity-weighting factor of 1, + Sum of %TBSA from all body regions affected by plaques x severity-weighting factor of 2, + Sum of %TBSA from all body regions affected by tumors x severity-weighting factor of 4 = TOTAL SWAT (maximum score=400)

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