Screening Genitalia for Chronic GVHD
Below are clinical manifestations that are potential early indicators of chronic GVHD of the genitalia. 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.
These guidelines are based on published diagnostic criteria from the National Institutes of Health (NIH) Consensus Development Project on chronic GVHD. [1,2,3]
- Visual inspection of genitalia
- Pelvic exam
Patient-Reported Symptoms and Signs
- Painful intercourse
- Painful urination
Lichen Planus-Like Features
Erythematous/violaceous tissue changes
Lichen Sclerosus-Like Features
White, atrophic papules that may coalesce into plaques
Females: Vaginal Scarring or Clitoral/Labial Agglutination
A narrowing of the vagina, often with accompanying tissue changes such as dryness, loss of elasticity and resilience, adhesion, and scar tissue
Males: Phimosis or Urethral/Meatus Scarring or Stenosis
A break or slit in tissue typically appearing at the junction of skin and mucous membrane
Localized destruction or loss of the epidermis
Localized destruction or loss below the epidermis
* Distinctive but 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
- Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Response Criteria Working Group Report. Biol Blood Marrow Transplant. 2015; 21(3): 389-401.
- Lee SJ, Wolff D, Kitko C, et al. Measuring therapeutic response in chronic graft-versus-host disease. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. The 2014 Response Criteria Working Group Report. Biol Blood Marrow Transplant. 2015; 21(6): 984-999.
- These guidelines have been developed by the National Marrow Donor Program® (NMDP)/Be The Match® 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 this document does not represent the official position of the NIH or the U.S. Government
Additional review from:
- Dennis L. Confer, M.D., NMDP/Be The Match, Minneapolis, Minn.
- Linda J. Burns, M.D., NMDP/Be The Match, Minneapolis, Minn.
- Madan Jagasia, M.D., Vanderbilt University Medical Center, Nashville, Tenn.
- 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 Graft-versus-Host Disease from Biology of Blood and Marrow Transplantation by American Society for Blood and Marrow Transplantation. Reproduced with permission of Elsevier, Inc.
- 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.