Table 3:

Evaluation of Multi-system Chronic Graft-versus-host Diseasea^a

Organ	ROS	Positive ROS	Negative ROS
Skin	Skin feels tight or hard, increased dryness, pruritus, rash, discoloration?	Dermatology consultation: clinical evaluation, biopsy, photographs, every 3 months or more often	Dermatology consultation: yearly
Sweat glands	Inability to sweat or to keep body warm?
Skin appendages	Loss of hair or nail changes?
Fasciae/joints	Stiffness or pain in the wrists, fingers, or other joints?	Assessment of range of motion: every visit Physical therapy consultation: every 3 months or more often	Assessment of range of motion: every visit
Eyes	Eye dryness, sensitivity to wind or dry environments, pain?	Ophthalmology consultation: every 3-6 months or more often	Ophthalmology consultation: 100 days after transplant, yearly
Mouth	Oral dryness, taste alterations, sensitivities (spicy, carbonate drinks, toothpaste), sores, pain?	Dental or oral medicine consultation: every 3-6 months or more often	Dental or oral medicine consultation: yearly or at symptom onset
Esophagus	Food or pills get stuck upon swallowing?	GI consultation for endoscopy
Lungs	Cough, shortness of breath, wheezes?	PFTs: 100 days after transplant, monthly for at least 3 months	PFTs: 100 days after transplant, every 3 months for 1 year, then as needed
Genital tract	Vaginal or penile pain, dyspareunia, dysuria, or sense of obstruction?	Gynecology/urogynecology consultation (female), Urology consultation (male)	Gynecology consultation: yearly or at symptom onset
Weight loss	Unexplained weight loss or inability to gain weight?	Weight every visit	Weight: every visit

^aAdapted from Flowers ME. How we treat chronic graft-versus-host disease. Blood. 2015, 125(4):606-615 Abbreviations: Review of systems, ROS; Gastroenterology, GI; pulmonary function tests, PFTs