Toward Standardized Screening for Chronic Graft-Versus-Host Disease: Insights From the Engraft Learning Network

Researchers from the Engraft Learning Health Network, led by Cleveland Clinic Foundation with collaborators from pediatric and adult transplant programs across the United States, have found substantial variation in how chronic graft-versus-host disease (cGVHD) is screened after allogeneic hematopoietic cell transplantation. Published in Transplantation and Cellular Therapy, the study showed that despite established NIH consensus criteria, accreditation standards, and CIBMTR reporting requirements, no uniform approach to screening was identified across participating centers. The findings highlight important gaps in surveillance and are being used to develop a streamlined, standardized cGVHD screening bundle for routine clinical practice.

Chronic GVHD affects up to 54% of allogeneic transplant recipients and is a leading cause of late non-relapse morbidity and mortality, making early recognition important before potentially irreversible organ damage develops. The investigators conducted a multicenter qualitative assessment across 10 Engraft centers, comprising eight pediatric and two adult transplant programs. Thirty-three clinicians participated in structured interviews, including 31 physicians and two advanced practice providers. The standardized interview assessed screening schedules, documentation, and organ-specific surveillance involving the skin, oral cavity, eyes, lungs, gastrointestinal and genitourinary systems, and musculoskeletal manifestations. Interviews were recorded, validated by participants, and analyzed using descriptive statistics and heat maps to characterize practice variation.

Screening practices varied considerably in both timing and scope. Only 52% (n=17) of clinicians reported monthly assessments during the first six months after day 100 post-transplant, and 37% (n=12) continued quarterly screening beyond one year. The Lee Symptom Scale was incorporated into routine documentation by just 10%. Although all respondents assessed skin symptoms, only 12% performed comprehensive skin examinations and 21% used structured cGVHD skin scoring. Pulmonary surveillance was concentrated around annual milestones, with fewer than 25% performing pulmonary function tests at recommended intermediate quarterly intervals. Genitourinary screening showed the greatest gaps: 42% did not routinely discuss symptoms with female patients and 63% did not with male patients, while rare manifestations such as neuropathy, serositis, cytopenias, and eosinophilia were routinely addressed by fewer than 10%. The study concludes that a practical, evidence-informed screening approach incorporating defined assessment intervals, structured organ-specific evaluation, pulmonary surveillance, and patient-reported outcomes could reduce practice variation and support earlier detection of cGVHD.

Reference:

Alkhouli L, Rotz S, Dandoy C, et al. Toward Standardized Screening for Chronic Graft-Versus-Host Disease: Insights from the Engraft Learning Network. Transplant Cell Ther. Published online August 2, 2026. https:doi.org/10.1016/j.jtct.2026.07.036