Screening Liver for Chronic GVHD
Below are clinical manifestations that are potential early indicators of chronic GVHD of the liver. If GVHD is suspected, timely collaboration with the patient’s transplant center is recommended to confirm the diagnosis and to develop and evaluate a treatment plan.
- Assess for hepatomegaly and right upper quadrant abdominal tenderness
- Total and direct bilirubin
- Alkaline phosphatase
- ALT: Alanine aminotransferase
- AST: Aspartate aminotransferase
- GGT: Gamma glutamyl transpeptidase
- 5'-NT: 5' Nucleotidase
- Liver biopsy is required to confirm GVHD involvement of the liver
Patient-Reported Symptoms and Signs
The flow of bile from the liver is blocked; documented by increased bilirubin or alkaline phosphate
* Insufficient alone to establish an unequivocal diagnosis of chronic GVHD without further testing or additional organ involvement
** Rare, controversial, or non-specific features of chronic GVHD
*** Common in both acute and chronic GVHD
- Filipovich AH, Weisdorf D, Pavletic S, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. Diagnosis and Staging Working Group Report. Biol Blood Marrow Transplant. 2005; 11(12): 945-956.
- Mitchell SA, Pavletic SZ. Measuring the therapeutic response in chronic GVHD trials: An instructional manual [CD]. Silver Spring, Maryland: Palladian Partners; 2006.
- These guidelines have been developed by the NMDP in consultation with Sandra A. Mitchell, CRNP, MScN, AOCN; National Institutes of Health Clinical Center; and Steven Z. Pavletic, M.D.; National Cancer Institute, National Institutes of Health, Bethesda, Md. The information in these pages does not represent the official position of the NIH or the U.S. Government.
Additional review from:
- Dennis L. Confer, M.D., National Marrow Donor Program, Minneapolis, Minn.
- Corey Cutler, M.D., Dana-Farber Cancer Institute, Boston, Mass.
- Stephanie J. Lee, M.D., Fred Hutchinson Cancer Research Center, Seattle, Wash.
Text adapted from reports of the NIH Consensus Development Project on Criteria for Clinical Trials in Chronic GVHD with permission from Biology of Blood and Marrow Transplantation and its publisher ASBMT.
- Photos/ Keratosis Pilaris; Lichen Planus-like; Hypopigmentation; Sclerosis; Erosion; Maculopapular: Maria L. Turner, M.D.; Edward W.Cowen, M.D.; Dermatology Branch, National Cancer Institute, NIH, Bethesda, Md.
- Photos/ Poikiloderma; Morphea; Lichen Planus-like; Lichen Sclerosus-like; Hyperpigmentation; Sclerosis; Nail dystrophy; Alopecia; Edema: Edward W. Cowen, M.D.; Dermatology Branch, National Cancer Institute, NIH, Bethesda, Md.
- Photos/ Lichen planus; Mucoceles; Erythema: Mark M. Schubert, D.D.S., M.S.D.; Fred Hutchinson Cancer Research Center, Seattle, Wash.
- Photo/ Keratoconjunctivitis: Mary E.D. Flowers, M.D.; University of Washington, Seattle, Wash.
- Photo/ Blepharitis: Janine A. Smith, M.D.; National Eye Institute, NIH, Bethesda, Md.
All photos used with permission.