Grading of minor salivary gland immuno-histopathology post-allogenic hematopoietic cell transplantation

Tollemar, Victor; Arvidsson, Hans; Häbel, Henrike; Tudzarovski, Nikolce; Legert, Karin Garming; Blanc, Katarina Le; Warfvinge, Gunnar; Sugars, Rachael V.

doi:10.1016/j.heliyon.2023.e15517

Cited by 3 publications

(14 citation statements)

References 44 publications

(170 reference statements)

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“…Acute and chronic salivary gland GVHD can affect the saliva production in both minor and major glandular structures, but the immunopathology has been principally assessed in the minor glands ( 46 , 66 , 67 , 70 – 73 ) Clinical signs of mucoceles and glandular enlargement, as well as xerostomia are described for both salivary gland cGVHD and Sjogren’s Syndrome, but links between salivary gland cGVHD and overall cGVHD severity remains controversial ( 16 , 35 , 66 , 71 , 74 ). Patients experiencing salivary gland dysfunction commonly report additional signs associated with a dry mouth, including mucoid viscous saliva, reduced or absent mucosal biofilm, the accumulation of soft debris and erythematous mucosa ( 75 ).…”

Section: Oral Cgvhdmentioning

confidence: 99%

“…A labial minor salivary gland biopsy should be used to verify the histopathological criteria of salivary gland cGVHD ( 14 ). Histological diagnosis (“possible or likely”) of salivary gland cGVHD has also been based on the NIH cGVHD histopathological consultation form, and the Chisholm-Mason composite score for Sjogren’s Syndrome ( 14 , 17 , 46 , 47 ). Periductal and acinar lymphocytic inflammation are considered specific for cGVHD ( 14 ).…”

Section: Oral Cgvhdmentioning

confidence: 99%

“…Periductal and acinar lymphocytic inflammation are considered specific for cGVHD ( 14 ). Typically, a mixed infiltrate involving both plasma cells and lymphocytes have been described ( 14 , 46 , 47 , 56 , 58 ). The presence of Sjogren’s Syndrome-like focused lymphocytic clusters is a contentious issue but salivary gland cGVHD could be related to diffuse peri-ductal and acinar inflammation rather than typical foci, which might depend on disease specificity, severity, and duration post-HCT ( 46 , 47 , 56 , 65 ).…”

Section: Oral Cgvhdmentioning

confidence: 99%

“…Typically, a mixed infiltrate involving both plasma cells and lymphocytes have been described ( 14 , 46 , 47 , 56 , 58 ). The presence of Sjogren’s Syndrome-like focused lymphocytic clusters is a contentious issue but salivary gland cGVHD could be related to diffuse peri-ductal and acinar inflammation rather than typical foci, which might depend on disease specificity, severity, and duration post-HCT ( 46 , 47 , 56 , 65 ). The NIH cGVHD histopathological consultation form specifically includes exocytosis with periductal and acinar inflammation, in contrast to the Chisholm-Mason composite score ( 14 , 46 , 47 ).…”

Section: Oral Cgvhdmentioning

confidence: 99%

“…The presence of Sjogren’s Syndrome-like focused lymphocytic clusters is a contentious issue but salivary gland cGVHD could be related to diffuse peri-ductal and acinar inflammation rather than typical foci, which might depend on disease specificity, severity, and duration post-HCT ( 46 , 47 , 56 , 65 ). The NIH cGVHD histopathological consultation form specifically includes exocytosis with periductal and acinar inflammation, in contrast to the Chisholm-Mason composite score ( 14 , 46 , 47 ). Identification of lymphocytic acinar migration with exocytosis is hard to assess and could be attributed to heavy inflammation leading to acinar destruction and difficulties in assessing acinar exocytosis ( 46 ).…”

Section: Oral Cgvhdmentioning

confidence: 99%

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Perspectives on oral chronic graft-versus-host disease from immunobiology to morbid diagnoses

2023

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Chronic Graft-versus-Host Disease (cGVHD) is a major long-term complication, associated with morbidity and mortality in patients following allogenic hematopoietic cell transplantation (HCT) for immune hematopoietic disorders. The mouth is one of the most frequently affected organs after HCT (45-83%) and oral cGVHD, which may appear as the first visible sign. Manifestations present with mucosal lichenoid lesions, salivary gland dysfunction and limited oral aperture. Diagnosis of oral cGVHD severity is based on mucosal lesions with symptoms of sensitivity and pain and reduced oral intake. However, diagnostic difficulties arise due to subjective definitions and low specificity to cover the spectrum of oral cGVHD. In recent years there have been significant improvements in our understanding of the underlying oral cGVHD disease mechanisms. Drawing upon the current knowledge on the pathophysiology and biological phases of oral cGVHD, we address oral mucosa lichenoid and Sjogren’s Syndrome-like sicca syndromes. We consider the response of alloreactive T-cells and macrophages to recipient tissues to drive the pathophysiological reactions and biological phases of acute inflammation (phase 1), chronic inflammation and dysregulated immunity (phase 2), and subsequent aberrant fibrotic healing (phase 3), which in time may be associated with an increased malignant transformation rate. When formulating treatment strategies, the pathophysiological spectrum of cGVHD is patient dependent and not every patient may progress chronologically through the biological stages. As such there remains a need to address and clarify personalized diagnostics and management to improve treatment descriptions. Within this review, we highlight the current state of the art knowledge on oral cGVHD pathophysiology and biological phases. We address knowledge gaps of oral cGVHD, with a view to facilitate clinical management and improve research quality on lichenoid biology and morbid forms of oral cGVHD.

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Section: Oral Cgvhdmentioning

confidence: 99%

Section: Oral Cgvhdmentioning

confidence: 99%

Section: Oral Cgvhdmentioning

confidence: 99%

Section: Oral Cgvhdmentioning

confidence: 99%

Section: Oral Cgvhdmentioning

confidence: 99%

See 3 more Smart Citations

Perspectives on oral chronic graft-versus-host disease from immunobiology to morbid diagnoses

2023

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Subjective Oral Dryness following Hematopoietic Cell Transplantation: A Report from the Orastem Study

Bulthuis,

van Leeuwen,

Thomas

et al. 2024

Transplantation and Cellular Therapy

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Oral Chronic Graft-Versus-Host Disease: Pathogenesis, Diagnosis, Current Treatment, and Emerging Therapies

Nguyen,

Jessri,

Costa-da-Silva

et al. 2024

IJMS

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Chronic graft-versus-host disease (cGvHD) is a multisystem disorder that occurs in recipients of allogeneic hematopoietic (alloHCT) stem cell transplants and is characterized by both inflammatory and fibrotic manifestations. It begins with the recognition of host tissues by the non-self (allogeneic) graft and progresses to tissue inflammation, organ dysfunction and fibrosis throughout the body. Oral cavity manifestations of cGVHD include mucosal features, salivary gland dysfunction and fibrosis. This review synthesizes current knowledge on the pathogenesis, diagnosis and management of oral cGVHD, with a focus on emerging trends and novel therapeutics. Data from various clinical studies and expert consensus are integrated to provide a comprehensive overview.

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Grading of minor salivary gland immuno-histopathology post-allogenic hematopoietic cell transplantation

Cited by 3 publications

References 44 publications

Perspectives on oral chronic graft-versus-host disease from immunobiology to morbid diagnoses

Perspectives on oral chronic graft-versus-host disease from immunobiology to morbid diagnoses

Subjective Oral Dryness following Hematopoietic Cell Transplantation: A Report from the Orastem Study

Oral Chronic Graft-Versus-Host Disease: Pathogenesis, Diagnosis, Current Treatment, and Emerging Therapies

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