cGvHD screening practices across transplant centers: A qualitative study

Results from a multicenter, qualitative study conducted within the Engraft Learning Health Network (LHN), characterizing chronic graft-versus-host disease (cGvHD) screening practices, were published in Transplantation and Cellular Therapy by Alkhouli et al. The study included 33 structured interviews with clinician representatives from ten transplant centers (eight pediatric and two adult), using a standardized guide addressing various screening domains: assessment schedules, documentation practices, and organ-specific screening of the skin, oral cavity, ocular, pulmonary, gastrointestinal, genitourinary, and musculoskeletal systems.

Key data: Monthly assessments during the first 6 months following Day 100 post-transplant were reported by 52% of respondents, while only 37% continued quarterly assessments beyond 1 year; 10% incorporated the Lee Symptom Scale (LSS) into routine documentation. All respondents routinely assessed skin symptoms, but comprehensive skin examination (12%) and structured cGvHD scoring (21%) were infrequent. Oral symptom assessment ranged from 18% to 63% across individual elements, while ocular symptom assessment ranged from 6% to 100%. Most respondents performed pulmonary function tests (PFTs) at annual milestones, but fewer than 25% reported PFTs at intermediate timepoints. Nausea, vomiting, diarrhea, and abdominal pain were universally assessed, whereas dysphagia (66%) and weight loss (37%) were less consistently screened. Genitourinary screening showed the greatest inconsistency, with 42% and 63% not routinely discussing symptoms with female and male patients, respectively. Musculoskeletal symptoms were assessed with moderate consistency.

Key learning: cGvHD screening practices varied across all domains examined, highlighting the need for a standardized, evidence-informed cGvHD screening approach in pediatric and adult transplant centers.