GVHD screening

Early detection of chronic graft-versus-host disease (GVHD) can help prevent irreversible organ damage and increase the quality of life of your transplant recipient.

Chronic GVHD, an immune response of the donor-derived T cells against recipient tissues, occurs in approximately 30–50% of patients receiving an allogeneic transplant. This is a serious, potentially life-threatening post-transplant complication. Uncontrolled chronic GVHD is associated with increased non-relapse mortality, significant morbidity and lower health-related quality of life. However, with ongoing surveillance, judicious management and multidisciplinary care, most cases of chronic GVHD resolve within 5 years and the median duration of treatment is 2–3 years.

GVHD that is characterized by red rash, diarrhea, and elevated liver tests, and that usually starts before day 100, is called acute GVHD. When people develop GVHD symptoms in their mouth, eyes, skin or other organs, it is called chronic GVHD. When symptoms appear, the treatment recommendation is: Collaborate with the transplant center to confirm the diagnosis and develop a treatment plan.

Important care principles

• Early detection and definitive diagnosis are essential for successful treatment
• Definitive diagnosis of chronic GVHD requires excluding other diagnoses such as infection, drug effects, malignancies and residual post-inflammatory damage and scarring
• Involvement of a multidisciplinary team is essential
• Both topical and/or systemic treatment may be appropriate
• Infection prophylaxis and prompt and effective management of infections are crucial; infection is a leading cause of death in chronic GVHD
• Long-term follow-up is required to monitor for late sequelae

Screening guidelines

Based on published diagnostic criteria from the National Institutes of Health (NIH) Consensus Development Project on Chronic GVHD [1,2,3], the following guidelines outline general principles of hematopoietic cell transplantation and the care of transplant recipients. These guidelines are intended to provide a framework and should not replace the medical judgment or advice of an experienced physician. Use the following information to:

• Identify clinical manifestations that are potential early indicators of chronic GVHD
• Trigger prompt clinical action if GVHD is suspected

These guidelines are also accessible through the Transplant Guidelines app for iOS or Android and the HCT Guidelines app.

If GVHD is suspected, it is recommended that you collaborate with the patient’s transplant center to confirm the diagnosis and to develop a treatment plan. Your early detection and actions to manage chronic GVHD can help minimize permanent damage and improve the quality of life of your transplant patient.

Access guidelines by organ/site

• Skin*
• Nails*
• Scalp and body hair*
• Eyes*
• Mouth*
• Lungs
• Muscles, fascia and joints*
• GI tract
• Liver
• Genitalia
• Hematopoietic and immune systems
• Other manifestations

Note: Pages marked with asterisks contain photos depicting clinical manifestations of chronic GVHD.

References

1. Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Response Criteria Working Group Report. Biol Blood Marrow Transplant. 2015; 21(3): 389-401.
2. Lee SJ, Wolff D, Kitko C, et al. Measuring therapeutic response in chronic graft-versus-host disease. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. The 2014 Response Criteria Working Group Report. Biol Blood Marrow Transplant. 2015; 21(6): 984-999.
3. These guidelines have been developed by NMDPSM in consultation with Seth Rotz, MD, Cleveland Clinic; Rachel Phelan, MD, Children’s Wisconsin and Medical College of Wisconsin; and Neil Bhatt, MD, and Paul Carpenter, MD, Fred Hutchinson Cancer Center.