Clinical manifestations of chronic GVHD
| Organ or site . | Diagnostic (sufficient for diagnosis) . | Distinctive (insufficient alone for diagnosis) . | Other . | Features seen in both acute and chronic GVHD . |
|---|---|---|---|---|
| Skin | Poikiloderma | Depigmentation | Erythema | |
| Lichen planus-like | Papulosquamous | Maculopapular | ||
| Sclerosis | Pruritus | |||
| Morphea-like | ||||
| Lichen sclerosis-like | ||||
| Nails | Dystrophy | |||
| Onycholysis | ||||
| Nail loss | ||||
| Pterygium unguis | ||||
| Scalp and body hair | Alopecia (scarring or nonscarring) | |||
| Scaling | ||||
| Mouth | Lichen planus-like | Xerostomia | Gingivitis | |
| Mucoceles | Mucositis | |||
| Mucosal atrophy | Erythema | |||
| Pseudomembranes or ulcers* | Pain | |||
| Eyes | New dry, gritty, or painful eyes (sicca) | |||
| Keratoconjunctivitis sicca | ||||
| Punctate keratopathy | ||||
| Genitalia | Lichen planus-like | Erosions* | ||
| Lichen sclerosis-like | Fissures* | |||
| Female: | Ulcers* | |||
| Vagina scarring or stenosis | ||||
| Clitoral or labial agglutination | ||||
| Male: | ||||
| Phimosis | ||||
| Urethral scarring or stenosis | ||||
| GI tract | Esophageal web | Diarrhea | ||
| Esophageal stricture | Anorexia | |||
| Nausea or emesis | ||||
| Failure to thrive | ||||
| Weight loss | ||||
| Liver | Total bilirubin, alkaline phosphatase or ALT >2× ULN | |||
| Lung | Bronchiolitis obliterans diagnosed by biopsy BOS§ | Cryptogenic organizing pneumonia† | ||
| Restrictive lung disease† | ||||
| Muscles, fascia, joints | Fasciitis | Myositis | ||
| Joint stiffness or contractures due to sclerosis | Polymyositis | |||
| Hematopoietic and Immune | Thrombocytopenia | |||
| Eosinophilia | ||||
| Hypo- or hypergammaglobulinemia | ||||
| Autoantibodies | ||||
| Raynaud phenomenon | ||||
| Others | Effusions‡ | |||
| Nephrotic syndrome | ||||
| Myasthenia gravis | ||||
| Peripheral neuropathy |
| Organ or site . | Diagnostic (sufficient for diagnosis) . | Distinctive (insufficient alone for diagnosis) . | Other . | Features seen in both acute and chronic GVHD . |
|---|---|---|---|---|
| Skin | Poikiloderma | Depigmentation | Erythema | |
| Lichen planus-like | Papulosquamous | Maculopapular | ||
| Sclerosis | Pruritus | |||
| Morphea-like | ||||
| Lichen sclerosis-like | ||||
| Nails | Dystrophy | |||
| Onycholysis | ||||
| Nail loss | ||||
| Pterygium unguis | ||||
| Scalp and body hair | Alopecia (scarring or nonscarring) | |||
| Scaling | ||||
| Mouth | Lichen planus-like | Xerostomia | Gingivitis | |
| Mucoceles | Mucositis | |||
| Mucosal atrophy | Erythema | |||
| Pseudomembranes or ulcers* | Pain | |||
| Eyes | New dry, gritty, or painful eyes (sicca) | |||
| Keratoconjunctivitis sicca | ||||
| Punctate keratopathy | ||||
| Genitalia | Lichen planus-like | Erosions* | ||
| Lichen sclerosis-like | Fissures* | |||
| Female: | Ulcers* | |||
| Vagina scarring or stenosis | ||||
| Clitoral or labial agglutination | ||||
| Male: | ||||
| Phimosis | ||||
| Urethral scarring or stenosis | ||||
| GI tract | Esophageal web | Diarrhea | ||
| Esophageal stricture | Anorexia | |||
| Nausea or emesis | ||||
| Failure to thrive | ||||
| Weight loss | ||||
| Liver | Total bilirubin, alkaline phosphatase or ALT >2× ULN | |||
| Lung | Bronchiolitis obliterans diagnosed by biopsy BOS§ | Cryptogenic organizing pneumonia† | ||
| Restrictive lung disease† | ||||
| Muscles, fascia, joints | Fasciitis | Myositis | ||
| Joint stiffness or contractures due to sclerosis | Polymyositis | |||
| Hematopoietic and Immune | Thrombocytopenia | |||
| Eosinophilia | ||||
| Hypo- or hypergammaglobulinemia | ||||
| Autoantibodies | ||||
| Raynaud phenomenon | ||||
| Others | Effusions‡ | |||
| Nephrotic syndrome | ||||
| Myasthenia gravis | ||||
| Peripheral neuropathy |
Modified from Stem Cell Trialists’ Collaborative Group.6
ALT, alanine aminotransferase; BOS, bronchiolitis obliterans syndrome; GI, gastrointestinal; ULN, upper limit of normal.
In all cases infection, drug effect, malignancy, endocrine causes must be excluded as applicable.
These pulmonary manifestations are under investigation or unclassified.
Pericardium, pleural, or ascites.
BOS can be diagnostic for lung chronic GVHD only, if distinctive feature present in another site.