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Toward Standardized Screening for Chronic GVHD: Insights from the Engraft Learning Network
Laila Alkhouli1, Seth Rotz1, Christopher Dandoy2
1Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Transplantation and Cellular Therapy
|August 2, 2026
Summary
Chronic graft-versus-host disease (cGVHD) screening lacks standardization across transplant centers, leading to inconsistent patient care. This study reveals wide variations in assessment schedules, documentation, and organ-specific evaluations, highlighting the need for a unified approach.
Area of Science:
- Hematopoietic cell transplantation (HCT)
- Immunology
- Oncology
Background:
- Chronic graft-versus-host disease (cGVHD) significantly impacts allogeneic HCT recipients, causing substantial morbidity and mortality.
- Current screening practices for cGVHD are inconsistent across transplant centers despite established guidelines.
- The Engraft Learning Health Network (LHN) initiated a study to assess cGVHD screening variability.
Purpose of the Study:
- To characterize current cGVHD screening practices within the Engraft LHN.
- To identify variations in screening approaches across transplant centers.
- To inform the development of a standardized cGVHD screening protocol.
Main Methods:
- A multicenter qualitative study involving 10 transplant centers (8 pediatric, 2 adult) within the Engraft LHN.
- Thirty-three structured interviews were conducted with clinician representatives.
- Screening domains included assessment schedules, documentation, and organ-specific evaluations (skin, oral, ocular, pulmonary, GI, GU, musculoskeletal); data were analyzed using descriptive statistics and heat maps.
Main Results:
- Significant heterogeneity in cGVHD screening was observed across all domains.
- Assessment schedules varied widely, with inconsistent adherence to recommended monthly or quarterly follow-ups.
- Gaps were noted in pulmonary function testing surveillance, genitourinary symptom assessment, and screening for rare manifestations like neuropathy and serositis.
Conclusions:
- Wide variations in timing, documentation, organ-specific assessment, and tool utilization exist in cGVHD screening.
- Current screening frameworks present practical challenges for routine implementation outside specialized clinics.
- A streamlined, evidence-informed screening bundle with defined intervals and integrated patient-reported outcomes is needed.
