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Published on: October 31, 2012
Oral Complications of Chronic Graft-Versus-Host Disease
Jane M Fall-Dickson1, Steven Z Pavletic2, Jacqueline W Mays2
1Department of Professional Nursing Practice, Georgetown University School of Nursing & Health Studies, Washington, DC.
Insights
Hematopoietic stem cell transplantation (HSCT) survivors face rising rates of chronic graft-versus-host disease (cGVHD), particularly oral cGVHD. This review highlights its impact, pathobiology, and research efforts to improve management.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Hematopoietic stem cell transplantation (HSCT) advancements have increased survival but also the incidence of graft-versus-host disease (GVHD).
- Chronic GVHD (cGVHD) affects nearly 50% of adult HSCT recipients, with oral cGVHD prevalence ranging from 45% to 83% among those with cGVHD.
- Oral cGVHD significantly impacts patient quality of life through symptoms affecting caloric intake, increasing infection risk, and necessitating greater healthcare utilization.
Purpose of the Study:
- To review the clinical significance of oral cGVHD in HSCT survivors.
- To summarize current knowledge of oral cGVHD pathobiology and identify existing evidence gaps.
- To discuss global research initiatives and challenges in managing oral cGVHD.
Main Methods:
- Literature review focusing on oral complications of cGVHD.
- Analysis of clinical significance, pathobiology, and management strategies.
- Inclusion of findings from major consensus projects like the NIH Consensus Development Project.
Main Results:
- Oral cGVHD is a prevalent and significant complication post-HSCT, impacting patient survival and well-being.
- Current understanding of oral cGVHD pathobiology has gaps, necessitating further research.
- Standard treatments include topical corticosteroids and calcineurin inhibitors, but challenges in management persist.
Conclusions:
- Oral cGVHD poses a substantial clinical challenge for HSCT survivors, affecting overall health and survival.
- Further interdisciplinary research is crucial to advance the scientific understanding and management of oral cGVHD.
- Addressing current management challenges is essential for improving outcomes in HSCT recipients.
Abstract:
The increasing clinical indications for hematopoietic stem cell transplantation (HSCT) and improved clinical care throughout and following HSCT have led to not only long-term survival but also to an increasing incidence and prevalence of graft-versus-host disease (GVHD). Chronic GVHD (cGVHD) affects almost 50% of adult patients post-HSCT, with increasing incidence in pediatric patients as well. Oral cGVHD specifically has a reported prevalence ranging from 45% to 83% in patients who develop cGVHD and is more extensive in adult patients than in children. Oral cGVHD affects patients through clinically significant oral symptoms that may lead to significantly decreased caloric intake, oral infections, and increased health service utilization, and may thus affect overall health and survival. The most commonly used therapy for mucosal involvement of oral cGVHD is topical high-dose and ultra-high potency corticosteroids, and calcineurin inhibitors. This review of oral complications of cGVHD presents the clinical significance of oral cGVHD to HSCT survivors, our current understanding of the pathobiology of oral cGVHD and gaps in this evidence, and the global targeted interdisciplinary clinical research efforts, including the National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease. Current challenges regarding the management of oral cGVHD and strategies to advance our scientific understanding of this clinically significant chronic oral disease are presented.
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