Assessment of Chronic GVHD Symptoms


Colleen Danielson, NP, walks through how chronic GVHD symptoms are assessed.


Yi-Bin Chen, MD: How do you assess a patient for chronic graft-versus-host disease [GVHD]? So, Colleen, once you’re seeing a patient 5-6 months out from transplant, when we are starting to ask when are they going to develop chronic graft-versus-host disease, when you see one of our patients in clinic, how do you go about trying to figure out if they’re starting to develop chronic GVHD?

Colleen Danielson, NP: It’s a complicated thing because there’s so many organs that could potentially be involved. And so, it’s a lot of teasing out questions and thinking about the organs that we know could be involved with GVHD. The skin by far is one of the common sites, both in acute and chronic. But what’s different in chronic is we have to assess for changes to the skin that could lead to indicate scleroderma. Tightness of the skin, a leathery feeling of the skin, a hardness that the patient’s experiencing, increased dryness, pruritus, and just that the skin looks different. Is there new discoloration, hyperpigmentation, hypopigmentation, a scaly appearance? Certainly, a new rash or papules on the skin. All of those things could be an indication of graft-versus-host disease. The sweat glands could be involved. We need to assess for the inability to sort of sweat to keep warm. And the other piece of this skin is the hair and nails.

Are there changes to those? Changes to the nails? Changes or loss of hair? That could be an indication of skin GVHD in the chronic phase. The joints and the fascia could be involved, and that could manifest as stiffness or pain in any of the joints. But we particularly are assessing in the wrists, fingers, and other joints. Is the patient able to move sort of in the way they used to or they’re noticing changes to their movable joints and their range of motion. With eye involvement, we know that this is very common. Patients can experience dryness of their eyes, sensitivity, particularly to the dry environments or the wind, and sometimes pain. Also, a foreign body sensation, a grittiness, or just it feels like something’s in their eyes, could all be an indication of eye involvement. With the mouth, we’re assessing for oral dryness, sensitivity, or pain in the mouth, particularly when they’re eating and drinking. Sometimes just brushing their teeth, that mintiness of the toothpaste can be bothersome, sores in their mouth or an alteration in their taste. Esophageal involvement can occur, and we mentioned on that before that could lead to a sensation of food getting stuck or pills getting stuck when they’re swallowing.

With potential lung involvement, we’re assessing for cough, certainly a chronic cough, shortness of breath, any wheezing. We know that the genital tract can be involved, and we do see a correlation when there’s oral involvement that there can be genital involvement with females in particular assessing for dryness, any pain, certainly pain with intercourse or any penetrative intercourse. And with men assessing for pain or dysuria, that could be an indication of stenosis of the urethra. And then also assessing for weight loss, any unexplained weight loss or inability to gain weight despite a good appetite and eating well.

Yi-Bin Chen, MD: You can see it’s a lot of questions and I don’t think we can depend on our patients to bring things up. I think a lot of what I’ve realized is education for our patients as to what we’re looking for. During this phase, a lot of our patients actually don’t want to be sick anymore. They’re probably tired of seeing us so much, and so the last thing they want is to develop something that’ll increase the frequency of their visits. So I think a lot of it is us educating them what we’re looking for so we can get the answers we need to get to understand that.

Transcript edited for clarity.

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