Toward a Better Understanding of the Atypical Features of Chronic Graft-Versus-Host Disease: A Report from the 2020 National Institutes of Health Consensus Project Task Force

The National Institutes of Health (NIH) consensus projects have improved understanding and standardized classification of the clinical features and diagnostic criteria for chronic GvHD. Although still unclear whether atypical manifestations are entirely due to chronic GvHD, these manifestations upon the hematopoietic system such as immune mediated cytopenias, endothelial dysfunction, or as atypical features in the musculoskeletal system, central and peripheral nervous system, kidneys, and serous membranes may contribute significantly to patient morbidity and mortality. This report provides provisional diagnostic criteria for each atypical manifestation, along with practical investigation strategies for clinicians managing patients with atypical chronic GvHD features.