Assessing the relationship between oral chronic graft-versus-host disease and global measures of quality of life

Abstract

Chronic GVHD (cGVHD) is a frequent complication of allogeneic hematopoietic stem cell transplantation (HSCT) and affects multiple organ systems, with the oral cavity being one of the most frequently affected sites. Patients with cGVHD experience reduced quality of life (QOL), yet the specific impact of oral cGVHD on QOL is poorly understood. OBJECTIVE The objective of this study was to characterize the impact of oral cGVHD on global measures of QOL. METHODS QOL data were collected using the FACT-BMT and SF-36 instruments for 569 patients enrolled in the Chronic GVHD Consortium, with a total of 1,915 follow-up visits. At study enrollment, patients were categorized as isolated oral cGVHD (n=22), oral and concomitant extra-oral cGVHD (n=420), and only extra-oral cGVHD (n=127). Utilizing all longitudinal data, QOL scores were compared using a multivariable linear model controlling for demographic, transplant, and cGVHD characteristics. RESULTS Patients with isolated oral cGVHD reported better physical well-being (P=0.009), BMT well-being (P=0.01), and decreased bodily pain (P=0.01) compared to patients with oral and concomitant extra-oral cGVHD, but the differences in scores did not reach the defined threshold for clinical significance (6 points for FACT-BMT domains and 5 points for SF-36 domains). CONCLUSIONS Global QOL scores are similar in patients with isolated oral cGVHD and patients with oral and concomitant extra-oral cGVHD.

Quality of Life after Allogeneic Hematopoietic Cell Transplantation According to Affected Organ and Severity of Chronic Graft-versus-Host Disease

“…Data from that study also indicated that physical QoL was lower than and mental QoL comparable with that of the general population. With regards to organ-specific symptoms, the Chronic GVHD Consortium reported the negative impact of GI, hepatic [20], ocular [21], and isolated mouth [19] GVHD on QoL. These analyses were conducted among patients who were diagnosed with GVHD and required systemic immunotherapy.…”

“…Its diverse symptoms and associated disability are major targets of treatment and care in the long-term follow-up clinic. With a growing awareness, emerging reports on the impact of chronic GVHD on QoL have shown not only that GVHD impairs QoL but also that among patients with chronic GVHD, QoL may differ by severity [11] or affected site [19][20][21]. However, it is still unclear how chronic GVHD clinically affects QoL by affected site and severity, especially in comparison with those who do not have GVHD symptoms.…”

Oral Lichen Planus or Oral Lichenoid Reaction? A Literature Review

“…3. GVHD: this is a condition that can occur after allogeneic bone marrow transplantation [18,60]. The lichenoid changes are common in the chronic type of GVHD, and lichenoid reactions have the highest positive predictive value for chronic GVHD [25].…”

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

“…cGVHD is a systemic disease with multiorgan involvement and a wide range of signs and symptoms with a major impact on patient's life quality (Baker & Fraser, ; DePalo, Chai, Lee, Cutler, & Treister, ; Fraser et al, ). In general, clinical features of cGVHD mimic multiple autoimmune or immune‐mediated conditions such as lichen planus, scleroderma, and systemic lupus erythematosus, characterized by chronic inflammation and fibrosis (Table ) (Baird & Pavletic, ).…”