Chronic graft‐versus‐host disease: Current management paradigm and future perspectives

Mawardi, Hani; Hashmi, Shahrukh K.; Sharon, Elad; Aljurf, Mahmoud; Treister, Nathaniel S.

doi:10.1111/odi.12936

Cited by 30 publications

(24 citation statements)

References 189 publications

(242 reference statements)

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“…In this regard, it is interesting to note that, in our study, four of the seven patients who developed OSCC were the recipients of HLA-identical sibling transplants. It is known that the degree of HLA disparity is the key determinant for GVHD risk and, in second line, for the onset of cancer [ 27 ]; therefore, in our cases, the development of OSCC in patients with a full HLA match between donor and recipient is attributable to a pathogenetic mechanism not associated with donor cells.…”

Section: Discussionmentioning

confidence: 75%

Oral Dysplastic Complications after HSCT: Single Case Series of Multidisciplinary Evaluation of 80 Patients

Leuci

Coppola

Blasi

et al. 2020

Life

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Oral squamous cell carcinoma (OSCC) is the most common secondary solid malignancy after hematopoietic stem-cell transplantation (HSCT). OSCC following HSCT is frequently preceded by chronic graft-versus-host disease (cGVHD). The aim of this study was to describe a cohort of post-HSCT patients and to evaluate the onset of oral epithelial dysplasia and/or OSCC over time. In this retrospective cohort study, we present a cohort of hematological patients that underwent HSCT. Demographic variables, clinical hematological data, data regarding acute graft-versus-host disease (aGVHD) and cGVHD, and oral clinical features were analyzed. We focused on clinicopathological features of a subgroup of 22 patients with oral cGVHD and OSCC after HSCT. Among 80 included patients, 46 patients (57.5%) developed aGVHD and 39 patients (48.7%) developed cGVHD. Oral mucosa was involved in 17 patients with aGVHD (36.9%) and in 22 patients (56.4%) with cGVHD. Out of a total of 22 oral biopsies, roughly 40% revealed mild to moderate dysplasia, and 32% were OSCC. In the absence of international agreement on the best timing of oral follow-up after HSCT, it is mandatory to establish a close multidisciplinary evaluation in order to prevent the onset of HSCT-related OSCC and to reduce post-transplant mortality due to secondary tumors.

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Section: Discussionmentioning

confidence: 75%

Oral Dysplastic Complications after HSCT: Single Case Series of Multidisciplinary Evaluation of 80 Patients

Leuci

Coppola

Blasi

et al. 2020

Life

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“…GVHD is a common and complex complication of allogeneic HSCT [4]. In patients with GVHD, a series of alloimmune reactions occur due to a mismatch in HLA antigens [5,6] leading to acute or chronic GVHD. Nowadays, the distinction between acute and chronic GVHD (cGVHD) is made based on clinical manifestations, rather than based on time after HSCT with a classic dividing line at 100 days [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Nowadays, the distinction between acute and chronic GVHD (cGVHD) is made based on clinical manifestations, rather than based on time after HSCT with a classic dividing line at 100 days [7,8]. Whereas acute GVHD typically presents specific clinical and histopathological features of the skin, liver, and/or gastrointestinal mucosa, chronic GVHD is defined as a systemic disease with multiorgan involvement, affecting the skin, mouth, genitals, eyes, liver, or lungs, presenting a wide range of signs and symptoms [5,[9][10][11]. Chronic GVHD is associated with increased morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of cGVHD ranges between 30 and 70% depending on differences in age, type of donor, and post-HSCT immunosuppressive therapy [5,11,13,14]. Clinical features of cGVHD mimic multiple autoimmune or immunemediated conditions characterized by chronic inflammation [5]. The oral cavity is one of the most frequently affected anatomical sites [7].…”

Section: Introductionmentioning

confidence: 99%

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Oral health–related quality of life of patients with oral chronic graft-versus-host disease

Stolze

Boor

Hazenberg

et al. 2021

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Purpose Symptoms of oral chronic graft-versus-host-disease (cGVHD) may significantly affect the oral health–related quality of life (OHRQoL). This study aimed to assess the OHRQoL in patients with oral cGVHD and to examine whether oral cGVHD symptoms, mucosal cGVHD, and salivary gland function correlated with OHRQoL. Methods Patients referred to the oral cGVHD outpatient clinic were included. Severity of oral mucosal cGVHD, oral cGVHD symptoms, and OHRQoL was assessed by the NIH OMS, NIH OSS, and OHIP-14, respectively. Unstimulated and stimulated whole salivary flow rates were determined and categorized into “hyposalivation,” “normal salivary flow,” and “hypersalivation.” Results Of 56 included patients, 80% had mild, moderate, or severe oral mucosal cGVHD. Mean total score of OHRQoL was 16.5 (±11.7), negatively affected by functional problems. Patients reported highest scores regarding oral sensitivity and xerostomia. Significant correlations were found between severity of oral pain and OHRQoL and between oral sensitivity and OHRQoL. No correlation was found between oral mucosal cGVHD and OHRQoL. Patients with hyposalivation, normal salivary flow, and hypersalivation reported equal levels of OHRQoL. Conclusion Results demonstrate that the OHRQoL was mostly negatively affected by complaints of oral pain and oral sensitivity and less by the severity of oral mucosal cGVHD assessed by the NIH OMS score. Special attention of (oral) health care professionals for patients with oral cGVHD is mandatory to alleviate their symptoms and improve OHRQoL.

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“…Acute GVHD usually has a limited course, but can be life threatening, while chronic GVHD can require long term treatment with immunosuppressive therapies which in turn place patients at risk of major complications specifically risk of infection. 3 Cutaneous manifestations are the most common sign of GVHD. Individuals suffering from cutaneous GVHD experience a variety of manifestations, including erythematous maculopapular morbilliform eruptions, follicular erythema, erythematous macular and popular rashes erythroderma, itching, dysthesia, sclerotic changes, pain, vulnerability to infection and impact on well-being and quality of life.…”

Section: Introductionmentioning

confidence: 99%

Skin and wound care for individuals with graft versus host disease: a scoping review protocol

et al. 2020

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IntroductionGraft versus host disease (GVHD) is a major cause of morbidity and mortality following allogenic haematopoietic stem cell transplantation. It is an immunological reaction, involving many organs, leading to a wide range of clinical manifestations. Cutaneous manifestations are the most common sign of GVHD, as well as pain, vulnerability to infection and impaired quality of life.Despite the burdens that cutaneous GVHD presents for patients, their carers and the healthcare system, limited evidence is available to guide day to day supportive skin care and wound management. Our objective is to conduct a scoping review to map the evidence for skin and wound management and identify evidence-practice gaps for individuals with acute or chronic cutaneous GVHD.Methods and analysisOur review will follow the scoping review methodological framework developed by Arksey and O’Malley and further refined by the Joanna Briggs Institute Scoping Review Methods Manual. Databases to be searched include; PubMed, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science and MEDLINE from 1970 to February 2020. Database searches will be supplemented with searches from relevant reference lists and grey literature. Descriptive statistical analyses will be performed.Ethics and disseminationThis scoping review does not require ethical approval. Findings will be disseminated through a peer-reviewed publication and conference presentation.

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Chronic graft‐versus‐host disease: Current management paradigm and future perspectives

Cited by 30 publications

References 189 publications

Oral Dysplastic Complications after HSCT: Single Case Series of Multidisciplinary Evaluation of 80 Patients

Oral Dysplastic Complications after HSCT: Single Case Series of Multidisciplinary Evaluation of 80 Patients

Oral health–related quality of life of patients with oral chronic graft-versus-host disease

Skin and wound care for individuals with graft versus host disease: a scoping review protocol

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