Assessing Severity and Clinical Significance of cGVHD Symptoms

Segment 3 addresses how clinicians assess cGVHD severity and determine when disease becomes clinically significant enough to warrant systemic therapy. Dr. DeFilipp describes cGVHD as an inherently subjective condition, with wide variability in symptom burden and functional impact across patients and organ systems.

The NIH consensus criteria are presented as the primary standardized framework for organ-specific scoring and global severity classification. Each organ is graded from 0 to 3, with cumulative involvement determining overall severity as mild, moderate, or severe. Lung involvement is highlighted as uniquely morbid and automatically upstages global severity, reflecting its prognostic importance.

Despite the utility of NIH criteria, Dr. DeFilipp emphasizes that clinical judgment remains essential. He notes that formal scoring often aligns with clinicians’ intuitive assessments but may not always drive treatment decisions. Instead, patient-reported quality-of-life impairment serves as a critical “north star.” The segment underscores that mild symptoms can be difficult to attribute definitively to cGVHD due to mimickers, whereas clinically significant disease is defined by functional limitation and patient distress. This perspective reinforces the need for individualized treatment thresholds.