Table 4.
National Institutes of Health recommended classification of clinical manifestations in chronic graft-versus-host disease
| Organ or site | Diagnostic (sufficient to establish the diagnosis of chronic GVHD) | Distinctive (seen in chronic GVHD but insufficient alone to establish a diagnosis) | Other features or unclassified entities | Common (seen with both acute and chronic GVHD) |
|---|---|---|---|---|
| Skin | Poikiloderma | Depigmentation | Sweat impairment | Erythema |
| Lichen planus-like features | Papulosquamous lesions | Ichthyosis | Maculopapular rash | |
| Sclerotic features | Keratosis pilaris | Pruritus | ||
| Morphea-like features | Hypopigmentation | |||
| Lichen sclerosus-like features | Hyperpigmentation | |||
| Nails | Dystrophy | |||
| Longitudinal ridging, splitting or brittle features | ||||
| Onycholysis | ||||
| Pterygium unguis | ||||
| Nail loss (usually symmetric, affects most nails) | ||||
| Scalp and body hair | Thinning scalp hair, typically patchy, coarse or dull (not explained by endocrine or other causes) | |||
| Premature gray hair | ||||
| Mouth | Lichen planus-like changes | Xerostomia | Gingivitis | |
| Mucoceles | Mucositis | |||
| Mucosal atrophy | Erythema | |||
| Ulcers | Pain | |||
| Pseudomembranes |
Adapted from Jagasia et al. [15]
GVHD graft-versus-host disease