Table 3. Signs and symptoms related to chronic Graft- versus -host-disease ( 10 , 11 ) .
| Organ or site | Diagnostic (sufficient to establish diagnosis of c-GVHD) | Characteristic (present in GVHD but not sufficient to establish diagnosis) | Other characteristics | Common to a-GVHD and c-GVHD |
|---|---|---|---|---|
| Skin | Poikiloderma | Depigmentation | Depigmentation | Erythema |
| Lichen planus | Excessive or absent sweating | Maculopapular rash | ||
| Sclerotic changes | Ichthyosis | Pruritus | ||
| Morphea | Keratosis pilaris Hypopigmentation | |||
| Lichen sclerosus | ||||
| Hyperpigmentation | ||||
| Hiperpigmentação | ||||
| Nail | Dystrophy | |||
| Longitudinal grooves | ||||
| Onycholysis | ||||
| Pterygium unguis | ||||
| Nail drop (usually symmetrically) | ||||
| Scalp and hair | Total alopecia or alopecia areata after post-chemotherapy recovery | Thinning of hair not explainable by other causes | ||
| Papulosquamous lesions | Early white hair | |||
| Mouth | Lichen-type changes | Xerostomia | Gingivitis | |
| Hyperkeratotic plates | Mucocele | Mucositis | ||
| Restriction of mouth opening by sclerosis | Mucosal atrophy | Erythema | ||
| Pseudomembranes | Pain | |||
| Ulcers | ||||
| Eye | Dry eye and eye pain | Photophobia | ||
| Healing conjunctivitis | Periorbital hyperpigmentation | |||
| Dry keratoconjunctivitis (Schrimer test <5mm/5 minutes) | Blepharitis | |||
| Keratitis punctata in confluent areas | ||||
| Genitals | Lichen planus | Erosions | ||
| Vaginal stenosis | Fissures | |||
| Ulcers | ||||
| GIT | Esophageal web | Exogenous pancreatic insufficiency | Anorexia | |
| Stricture or stenosis in the proximal third of the esophagus | Nausea | |||
| Vomiting | ||||
| Diarrhea | ||||
| Weight loss | ||||
| Liver | Total bilirubin and alkaline phosphatase | |||
| >twice above the normal limit | ||||
| ALT or AST > twice the upper limit | ||||
| Lungs | Bronchiolitis obliterans diagnosed with biopsy | Bronchiolitis obliterans diagnosed with pulmonary function test or chest computed tomography | BOOP | |
| Muscle, fascia, joints | Fasciitis | Myositis or polymyositis | Edema | |
| Joint contractures secondary to sclerosis | Cramps | |||
| Joint stiffness | Arthralgia or arthritis | |||
| Hematopoietic and immune systems | Thrombocytopenia | |||
| Eosinophilia | ||||
| Lymphopenia | ||||
| Hypo- or hypergammaglobulinemia | ||||
| Autoantibodies (AIHA and ITP) | ||||
| Other | Pleural or pericardial effusion | |||
| Ascites | ||||
| Peripheral neuropathy | ||||
| Nephrotic syndrome | ||||
| Myasthenia gravis | ||||
| Cardiomyopathy or cardiac conduction defects |
c-GVHD: chronic Graft versus host disease; GVHD: Graft- versus -host disease; a-GVHD: acute Graft- versus -host disease; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BOOP: Bronchiolitis obliterans with organizing pneumonia; AIHA: Autoimmune hemolytic anemia; ITP: Immune thrombocytopenia purpura.