Occurs between 100-300d post-allogeneic transplant. There may not have been preceding acute GvHD, and acute GvHD may have resolved prior to onset of chronic GvHD. Conventionally subdivided into limited or extensive chronic GvHD. Major clinical features are debility, weight loss with malabsorption, sclerodermatous reaction due to excessive collagen deposition, severe immunosuppression and features of autoimmune disease.

Limited chronic GvHD: clinical features

• Localised skin involvement <50% total surface.

• Hepatic dysfunction—portal lesions but lacking necrosis, aggressive hepatitis or cirrhosis.

• Other localised involvement of eyes, salivary glands and mouth.

Extensive chronic GvHD—clinical features

• Generalised skin involvement >50% of surface—may include sclero-dermatous changes and ulceration.

• Abnormal liver function—histology shows centrilobular changes, chronic aggressive hepatitis, bridging necrosis or cirrhosis.

• Liver dysfunction ± localised skin GvHD with involvement of eyes, salivary glands or oral mucosa on labial biopsy.

• Involvement of any other major organ system.

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