Foundations of cGVHD Diagnosis and Severity Assessment

Leyla Shune, MD, outlines a practical, patient-centered approach to diagnosing and managing chronic graft-versus-host disease (cGVHD) following allogeneic stem cell transplantation. She emphasizes the use of NIH consensus criteria as the foundation for diagnosis and severity grading, with systematic evaluation of organ involvement to generate an overall severity score. Certain clinical manifestations, particularly dermatologic findings such as lichen planus-like changes, poikiloderma, micropapular rashes, and sclerosis, are noted as highly characteristic and often pathognomonic for cGVHD.

Dr. Shune notes that despite ongoing research, validated biomarkers for cGVHD are not yet available for routine clinical use. As a result, clinical judgment remains critical, especially in situations where tissue biopsy is not feasible. In such cases, empiric corticosteroid therapy may be initiated, with treatment response serving as both a therapeutic and diagnostic guide.

She also discusses the importance of a multidisciplinary care model in both diagnosis and longitudinal management. Pulmonologists assist with evaluation of abnormal pulmonary function tests, exclusion of infectious or alternative etiologies, and co-management with imaging and inhaled therapies. Dermatologists contribute to diagnostic clarification through clinical assessment and biopsy, whereas ophthalmologists play a key role in early detection and management of ocular GVHD, including interventions such as tear duct plugs and scleral lenses for severe dry eye disease.

Patient education is presented as a cornerstone of effective cGVHD management. Dr. Shune stresses proactive counseling at the time of discharge, when cGVHD is most likely to emerge. Patients and caregivers are instructed to monitor for subtle symptoms involving the skin, hair, nails, eyes, and oral cavity and to report concerns promptly. Early recognition and intervention are emphasized as critical to preventing irreversible complications such as late-stage sclerosis. Access to care is facilitated through coordinated education by physicians, nurse practitioners, survivorship teams, and GVHD specialists, as well as through telehealth and electronic communication platforms to ensure timely evaluation and treatment.