Oral graft-versus-host disease.

Area of Science:

• Hematology
• Immunology
• Oral Medicine

Background:

• Graft-versus-host disease (GVHD) is a major complication following hematopoietic cell transplantation (HCT).
• Chronic GVHD (cGVHD) affects 40-70% of surviving patients, requiring prolonged, multidisciplinary management.
• The oral manifestations of cGVHD represent a significant aspect of this post-transplant complication.

Purpose of the Study:

• To review the oral component of chronic graft-versus-host disease (cGVHD) following hematopoietic cell transplantation (HCT).
• To discuss the current understanding of oral cGVHD pathophysiology, prevalence, and treatment challenges.

Main Methods:

• Literature search from 1966 to 2008 using MEDLINE/PubMed.
• Focused on GVHD pathophysiology, salivary gland disease post-HCT, and oral GVHD treatments.
• Limited to peer-reviewed English language journals.

Main Results:

• Understanding of oral cGVHD pathophysiology is extrapolated from studies of other affected tissues.
• Prevalence and incidence of salivary gland disease are difficult to ascertain due to a lack of a universal case definition.
• Existing clinical trials for oral cGVHD are generally small, limiting strong treatment recommendations.

Conclusions:

• Larger, well-designed clinical studies are essential.
• Further research is required to elucidate the pathophysiology of oral cGVHD.
• Improved understanding will guide the development of optimal treatment strategies for oral cGVHD.