A Review on Therapeutic Management for Oral Chronic Graft-versus-Host Disease
AbstractChronic graft-versus-host disease (cGVHD) is one of the main complications of transplantation in allogeneic hematopoietic cells which results in reduced quality of life. cGVHD mostly affects the oral cavity, producing various symptoms and manifestations. It can lead to both short- and long-term complications such as limited oral intake, mucosal sensitivity, secondary malignancy and even early death. GVHD is an alloimmune and autoimmune disorder with a variable clinical course that commonly involves various tissues and organs. It can occur in both the acute and chronic forms. In the case of cGVHD, a large number of organs are affected including the oral cavity. However, in some cases of cGVHD only the oral cavity gets affected. The clinical indications of chronic oral GVHD may include sclerosis, hyperkeratotic plaques, lichenoid lesions, and limited oral aperture. The level of oral involvement is commonly mild, but medium to high severity erosive as well as ulcerated lesions may also be occurred. Although diagnosed through clinical examination, its confirmation is usually done by biopsy study. The first treatment option is using local corticosteroids with the potency to treat half of patients. Extracorporeal photopheresis and systemic corticosteroids are in the next ranks. Patient survival after diagnosis of oral chronic GVHD is within 4.5 years in 50% of the cases, thus it is not regarded as a determinant factor in patient survival. This study attempted to provide a detailed approach for clinical diagnosis and management of patients suffered from oral cGVHD. It is particularly considered the factors such as differential diagnosis, symptom control, screening for and prevention of secondary complications. It has been tried to provide practical and relevant considerations and recommendations for all clinicians who dealswith oral cGVHD patients in order to achieve improved care and outcomes.
. Kuten-Shorrer M, Woo SB, Treister NS. 2014. Oral graft-versus-host disease. Dent Clin North Am.58:351-68.
. Dignan FL, Clark A, Amrolia P, et al. 2012b. Diagnosis and management of acute graft-versus-host disease. Br J Haematol.158:30-45.
. Jaglowski SM, Devine SM. 2014. Graft-versus-host disease: why have we not made more progress? Curr Opin Hematol.21:141-7.
. Paczesny S. 2013. Discovery and validation of graft-versus-host disease biomarkers. Blood. 121:585-94.
. Linhares YP, Pavletic S, Gale RP. 2013. Chronic GVHD: Where are we? Where do we want to be? Will immunomodulatory drugs help? Bone Marrow Transplant.48:203-9.
. Travnik R, Beckers M, Wolff D, et al. 2011. Graft-versus-Host Disease (GvHD) - an update: Part 1: Pathophysiology, clinical features and classifcation of GvHD. Hautarzt.62:139-54.
. Elad S, Zeevi I, Resnick IB, et al. 2010. Valida-tion of the National Institutes of Health (NIH) scale for oral chronic graft-versus-host disease (cGVHD). Biol Blood Marrow Transplant.16:62-9.
. Michael T. B, Bengt H, Allan J. H, 2018. Impact of Oral Side Effects from Conditioning Therapy Before Hematopoietic Stem Cell Transplantation: Protocol for a Multicenter Study. JMIR Res Protoc. 7(4): e103.
. Salmasian H, Rohanizadegan M, Banihosseini S, et al. 2010. Corticosteroid regimens for treatment of acute and chronic graft versus host disease (GvHD) after allogenic stem cell transplantation. Cochrane Database Syst Rev.20:CD005565.
. Arai S, Jagasia M, Storer B, et al. 2011. Global and organ-specific chronic graft-versus-host disease severity according to the 2005 NIH Consensus Criteria. Blood. 118(15):4242-4249.
. Claudio A, Brent R. L, Stephanie J. L, 2013. Peripheral-Blood Stem Cells versus Bone Marrow from Unrelated Donors. N Engl J Med. 367(16): 10.1056/NEJMoa1203517.
. Jacobsohn DA. 2010. Optimal management of chronic graft-versus-host disease in children. Br J Haematol.150(3):278-292.
. Flowers ME, Inamoto Y, Carpenter PA, et al. 2011. Comparative analysis of risk factors for acute graft-versus-host disease and for chronic graftversus-host disease according to National Institutes of Health consensus criteria. Blood. 117(11):3214-3219.
. Kelli P. A, Geoffrey R. H, Bruce R. B. 2017. Chronic graft-versus-host disease: biological insights from preclinical and clinical studies. Blood. 129:13-21.
. Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital. 2018. 2018 update on chronic graft-versus-host disease. Rinsho Ketsueki. 2018;59(10):2300-2306.
. Arora M, Klein JP, Weisdorf DJ, et al. 2011. Chronic GVHD risk score: A Center for International Blood and Marrow Transplant Research analysis. Blood. 117:6714–20.
. Ferrara JL, Levine JE, Reddy P, et al. 2009 Graft-versus-host disease. Lancet. 373:1550-61.
. Meier JK, Wolff D, Pavletic S, et al. 2011. Oral chronic graft-versus-host disease: report from the International Consensus Conference on clinical practice in cGVHD. Clin Oral Investig. 15:127–39.
. Mays JW, Fassil H, Edwards DA, et al. 2013. Oral chronic graft-versus-host disease: current pathogenesis, therapy, and research. Oral Dis. 19:327-46.
. Maria M, José V. B, Yolanda J, et al. 2015. Graft-versus-host disease affecting oral cavity. A review. J Clin Exp Dent. 7(1): e138-45.
. Mahesh K, Sujay K. 2011. Acute graft versus host disease. Indian journal of dermatology, venereology and leprology 77(2):217-9.
. Blazar BR, Murphy WJ, Abedi M. 2012. Advances in graft-versus-host disease biology and therapy. Nat Rev Immunol. 12:443–58.
. Robert Z, Bruce R. B. 2016. Preclinical models of acute and chronic graft-versus-host disease: how predictive are they for a successful clinical translation? Blood 2016 127:3117-3126.
. Schroeder MA, DiPersio JF. 2011. Mouse models of graft-versus-host disease: advances and limitations. Dis Model Mech. 4:318–33.
. Piccin A, Tagnin M, Vecchiato C, et al. 2018. Graft-versus-host disease (GvHD) of the tongue and of the oral cavity: a large retrospective study. Int J Hematol. 108(6):615-621.
. Stefanie S, Adela R. C, Keith M. S. 2019. How I treat refractory chronic graft-versus-host disease. Blood. 133(11):1191-1200.
. JW Mays, H Fassil, DA Edwards, et al. 2013. Oral Chronic Graft-versus-Host Disease: Current Pathogenesis, Therapy, and Research. Oral Dis. 19(4): 327–346.’
. Imanguli MM, Atkinson JC, Mitchell SA, et al. 2010. Salivary gland involvement in chronic graft-versus-host disease: prevalence, clinical significance, and recommendations for evaluation. Biol Blood Marrow Transplant. 16:1362–9.
. Julia S, Rosa-María L. P, José G. S, 2018. Oral lesions in Sjögren’s syndrome: A systematic review. Med Oral Patol Oral Cir Bucal. 2018 Jul 1;23 (4): e391-400.
. Carpenter P. A, Kitko C. L, Elad S, et al. 2015. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report. Biol Blood Marrow Transplant. 21(7):1167-87.
. Diana M. C, Claire J. D, Michael J. S, et al. 2017. Use of the National Institutes of Health ConsensusGuidelines Improves the Diagnostic Sensitivity ofGastrointestinal Graft-Versus-Host Disease. Arch Pathol Lab Med. 142:1098–1105.
. Nathaniel Treister, Christine Duncan, Corey Cutler, et al. 2012. How we treat oral chronic graft-versus-host disease. Blood. Volume 120, number 17.
. Hull KM, Kerridge I, Schifter M. 2012. Long-term oral complications of allogeneic haematopoietic SCT. Bone Marrow Transplant. 47(2):265–70.
. Garming-Legert K, Remberger M, Ringden O, Hassan M, Dahllof G. 2011. Long-term salivary function after conditioning with busulfan, fractionated or single-dose TBI. Oral Dis. 17:670–6.
. Fassil H, Bassim CW, Mays J, et al. 2012. Oral Chronic Graft-vs.-Host Disease Characterization Using the NIH Scale. Journal of Dental Research. 91: S45–S51.
. Laura G. C, Renata L. F, Carmem B, et al. 2015. Oral Manifestations Compatible with Chronic Graft-versus-Host Disease in Patients with Fanconi Anemia. Volume 21, Issue 2, Pages 275-280.
. Hani M, Shahrukh K. H, Sharon E, et al. 2018. Chronic graft‐versus‐host disease: Current management paradigm and future perspectives. Volume25, Issue4, Pages 931-948.
. Daniel W, Armin G, Francis A, et al. 2010. Consensus Conference on Clinical Practice in Chronic Graft-versus-Host Disease (GVHD): First-Line and Topical Treatment of Chronic GVHD. Biology of Blood and Marrow Transplantation, Volume 16, Issue 12, Pages 1611-1628.
. Castellarin P, Stevenson K, Biasotto M, et al. 2012. Extensive dental caries in patients with oral chronic graft-versus-host disease. Biol Blood Marrow Transplant.
. Hamid R. M, Masoud S, Ladan J, et al. 2018. Oral manifestation and dental management in a patient with chronic graft versus host disease with around a 10-year follow-up. Vol 5 No 6, 2370-2377.
. Bollero P, Passarelli P. C, D'Addona A, et al. 2018. Oral management of adult patients undergoing hematopoietic stem cell transplantation. Eur Rev Med Pharmacol Sci. 22(4):876-887.
. Valéria C. C. 2014. Cochrane fluoride reviews: an overview of the evidence on caries prevention with fluoride treatments. Volume: 5 Issue: 2, pp. 78-83.
. Cochrane NJ, Cai F, Huq NL, et al. 2010. New approaches to enhanced remineralization of tooth enamel. J Dent Res.89(11):1187-1197.
. Wolff D, Gerbitz A, Ayuk F, et al. 2010. Consensus conference on clinical practice in chronic graftversus-host disease (GVHD): first-line and topical treatment of chronic GVHD. Biol Blood Marrow Transplant. 16:1611–28.
. Joseph P. 2011. Graft-Vs-Host Disease following Allogeneic Hematopoietic Cell Transplantation. Blood and Marrow Transplant Program, Volume: 18 issue: 4, page(s): 268-276.
. Elad S, Zeevi I, Finke J, et al. 2012. Improvement in oral chronic graft-versus-host disease with the administration of effervescent tablets of topical budesonide-an open, randomized, multicenter study. Biol Blood Marrow Transplant. 18:134–40.