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Chronic graft-versus-host disease: Clinical features and grading systems

Chronic graft-versus-host disease (GVHD) is the prime cause of transplantation-related mortality late after marrow grafting and contributes directly or indirectly to most nonmalignant complications. The main clinical symptoms and diagnostic problems of chronic GVHD are summarized here.A major issue in treating chronic GVHD is to assess disease severity.A critical review of published grading systems failed to demonstrate that any system is better than the others. Prospective validation of the Johns Hopkins grading scale is timely and warranted.