Evaluation and frequency of monitoring according symptoms or affected organs
| Evaluation . | Frequency of evaluation/monitoring . | |
|---|---|---|
| Manifestations present . | Manifestations absent . | |
| Review of systems (see Table 3 for chronic GVHD-specific questions) | Every clinic visit | Every clinic visit |
| Physical examination | ||
| Complete skin examination (look, touch, pinch) | Every clinic visit | Every clinic visit |
| Oral examination | Every clinic visit | Every clinic visit |
| Range of motion assessment | Every clinic visit | Every clinic visit |
| Performance score | Every clinic visit | Every clinic visit |
| Nurse assessment | ||
| Weight | Every clinic visit | Every clinic visit |
| Height/adults | Yearly | Yearly |
| Height/children | Every 3-12 mo | Every 3-12 mo |
| Medical photographs | ∼100 d after HCT (baseline), at initial diagnosis of chronic GVHD, every 6 mo if skin or joints are involved and during treatment until at least 1 y after discontinuation of treatment | ∼100 d after HCT (baseline) |
| Other evaluations | ||
| PFTs | ∼100 d after HCT (baseline); see also Table 4 | ∼100 d after HCT and every 3 mo for the first year, then yearly if previous PFTs were abnormal or if continuing systemic treatment; reassess at onset of new symptoms |
| Nutritional assessment | As clinically indicated and yearly if receiving corticosteroids | As clinically indicated |
| Physiotherapy with assessment of range of motion | Every 3 mo if sclerotic features affecting range of motion until resolution | As clinically indicated |
| Dental or oral medicine consultation with comprehensive soft and hard tissue examination, culture, biopsy, or photographs of lesions, as clinically indicated | Every 3-6 mo or more often as indicated | Yearly |
| Ophthalmology consultation with Schirmer test, slit-lamp examination, and intraocular pressure | At initial diagnosis and every 3-6 mo or more often as indicated | ∼100 d after HCT (baseline) and yearly |
| Gynecology examination for vulvar or vaginal involvement | Every 6 mo or more often as indicated | Yearly |
| Dermatology consultation with assessment of extent and type of skin involvement, biopsy, or photographs | As clinically indicated | |
| Neuropsychological testing | As clinically indicated | |
| Bone mineral assessment (DEXA) scan | Yearly during corticosteroid treatment or if prior test was abnormal | ∼100 d after HCT if continuing corticosteroid treatment (baseline) |
| Evaluation . | Frequency of evaluation/monitoring . | |
|---|---|---|
| Manifestations present . | Manifestations absent . | |
| Review of systems (see Table 3 for chronic GVHD-specific questions) | Every clinic visit | Every clinic visit |
| Physical examination | ||
| Complete skin examination (look, touch, pinch) | Every clinic visit | Every clinic visit |
| Oral examination | Every clinic visit | Every clinic visit |
| Range of motion assessment | Every clinic visit | Every clinic visit |
| Performance score | Every clinic visit | Every clinic visit |
| Nurse assessment | ||
| Weight | Every clinic visit | Every clinic visit |
| Height/adults | Yearly | Yearly |
| Height/children | Every 3-12 mo | Every 3-12 mo |
| Medical photographs | ∼100 d after HCT (baseline), at initial diagnosis of chronic GVHD, every 6 mo if skin or joints are involved and during treatment until at least 1 y after discontinuation of treatment | ∼100 d after HCT (baseline) |
| Other evaluations | ||
| PFTs | ∼100 d after HCT (baseline); see also Table 4 | ∼100 d after HCT and every 3 mo for the first year, then yearly if previous PFTs were abnormal or if continuing systemic treatment; reassess at onset of new symptoms |
| Nutritional assessment | As clinically indicated and yearly if receiving corticosteroids | As clinically indicated |
| Physiotherapy with assessment of range of motion | Every 3 mo if sclerotic features affecting range of motion until resolution | As clinically indicated |
| Dental or oral medicine consultation with comprehensive soft and hard tissue examination, culture, biopsy, or photographs of lesions, as clinically indicated | Every 3-6 mo or more often as indicated | Yearly |
| Ophthalmology consultation with Schirmer test, slit-lamp examination, and intraocular pressure | At initial diagnosis and every 3-6 mo or more often as indicated | ∼100 d after HCT (baseline) and yearly |
| Gynecology examination for vulvar or vaginal involvement | Every 6 mo or more often as indicated | Yearly |
| Dermatology consultation with assessment of extent and type of skin involvement, biopsy, or photographs | As clinically indicated | |
| Neuropsychological testing | As clinically indicated | |
| Bone mineral assessment (DEXA) scan | Yearly during corticosteroid treatment or if prior test was abnormal | ∼100 d after HCT if continuing corticosteroid treatment (baseline) |
Modified from Flowers and Vogelsang.69