How I conduct a comprehensive chronic graft-versus-host disease assessment

Since the National Institutes of Health Chronic Graft-Versus-Host Disease (cGVHD) Consensus Project in 2005, a need has emerged to evaluate cGVHD more methodically, not only to make a cGVHD diagnosis, but also to accurately classify individual organ and global organ severity, at baseline and in follow-up so that subjects participating in clinical trials may reliably be assigned an accurate response category irrespective of the evaluator. Even for patients not enrolled on a clinical trial, periodic complete cGVHD assessments can allow subtle manifestations to be detected, monitored carefully, and/or treated early with the goal of hopefully avoiding progression to highly morbid, difficult to treat, and quite often irreversible forms of cGVHD. Early feedback has been that the National Institutes of Health approach to diagnosis classification, staging, and response, as well as other new assessment tools, are too detailed and overly complex. This article tries to address many of these issues by describing how I conduct a comprehensive cGVHD assessment using a streamlined and reliable method that I use regularly within the constraints of a busy clinic.