Clinical approach in the management of oral chronic graft-versus-host disease (cGVHD) in a series of specialized medical centers

Sharon, Elad; Jensen, Siri Beier; Raber-Durlacher, Judith E.; Mouradian, Nancy; Correa, Elvira M. P.; Schubert, Mark M.; Blijlevens, Nicole M. A.; Epstein, Joel B.; Saunders, Deborah; Waltimo, Tuomas; Yarom, Noam; Zadik, Yehuda; Brennan, Michael T.

doi:10.1007/s00520-014-2503-x

Cited by 15 publications

(13 citation statements)

References 46 publications

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“…All patients undergoing HSCT should receive specific care, particularly those who develop cGVHD. A complete dental evaluation should occur regularly, and special attention should be focused on early detection of oral cancer and precursor lesions [ 14 , 17 , 18 , 28 ]; diagnosis and treatment of mucosal lesions [ 14 , 28 ] and erythema or lichen-type features with symptomatology [ 18 ]; caries prevention [ 14 , 28 , 29 ]; reestablishment of oral health in case of rampant caries [ 14 , 30 ], with the possibility of use of fluoride applications [ 14 ] or silver diamine fluoride for disease control and relief of hypersensitivity [ 30 ]; and pharmacological treatment [ 14 , 28 , 31 ] or nonpharmacological treatment [ 14 , 28 , 29 ] of hyposalivation and xerostomia.…”

Section: General Considerations Regarding Dental Treatmentmentioning

confidence: 99%

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Dental Treatment in Patients with Leukemia

Zimmermann

Meurer

Grando

et al. 2015

Journal of Oncology

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Dental treatment of patients with leukemia should be planned on the basis of antineoplastic therapy which can be chemotherapy with or without radiotherapy and bone marrow transplantation. Many are the oral manifestations presented by these patients, arising from leukemia and/or treatment. In addition, performing dental procedures at different stages of treatment (before, during, or after) must follow certain protocols in relation to the haematological indices of patients, aimed at maintaining health and contributing to the effectiveness of the results of antineoplastic therapy. Through a literature review, the purpose of this study was to report the hematological abnormalities present in patients with leukemia, trying to correlate them with the feasibility of dental treatment at different stages of the disease. It is concluded in this paper that dental treatment in relation to haematological indices presented by patients with leukemia must follow certain protocols, mainly related to neutrophil and platelet counts, and the presence of the dentist in a multidisciplinary team is required for the health care of this patient.

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Section: General Considerations Regarding Dental Treatmentmentioning

confidence: 99%

“…The diagnosis of oral cGVHD depends on the patient's history, clinical findings, and early signs and symptoms [ 14 ] and it is generally not necessary to perform a biopsy [ 28 ].…”

Section: General Considerations Regarding Dental Treatmentmentioning

confidence: 99%

Dental Treatment in Patients with Leukemia

Zimmermann

Meurer

Grando

et al. 2015

Journal of Oncology

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“…There was a heterogeneity regarding the trial outcomes and outcome assessment and the mixed study design hindered gathering the studies for statistical analysis. It is acknowledged for most practitioners that topical corticosteroids are the first line of treatment for oral cGVHD [ 1 , 4 , 14 ]. Upon evaluation of the available evidence we agree on the net benefit of topical corticosteroids with a recommendation to “probably” the use of topical steroid is effective in management of signs and symptoms of oral mucosal GVHD with minimal easily avoided side effects.…”

Section: Discussionmentioning

confidence: 99%

“…The review could not make recommendations regarding any topical intervention in oral cGVHD. Another study [ 14 ], a clinical survey, was conducted assessing clinical interventions for diagnosis and management of oral cGVHD. They reported that topical corticosteroids were the first line of treatment chosen by oral specialists.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Topical Corticosteroids for Management of Oral Chronic Graft versus Host Disease

Elsaadany

Ahmed

Aghbary

2017

International Journal of Dentistry

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Background Oral chronic graft versus host disease (cGVHD) is a major complication in transplantation community, a problem that can be addressed with topical intervention. Topical corticosteroids are the first line of treatment although the choice remains challenging as none of the available treatments is supported by strong clinical evidence. Objective This systematic review aims to determine the clinical efficacy and safety of topical corticosteroids for the management of the mucosal alterations of oral cGVHD. Data Sources Electronic search of different databases was conducted: PubMed, Cochrane library, Grey literature, WHO, and clinical trials.gov for clinical trial registration as well as hand search in the references of relevant articles up to November 2016. Data Extraction Extracted pieces of information were intervention, population, sample sizes, and outcomes. Data Synthesis Six studies were included: 2 randomized clinical trials (RCTs), 3 cohort studies, and 1 pre-post clinical trial. Results There is a limited evidence concerning clinical efficacy of topical corticosteroids. Clobetasol, dexamethasone, and budesonide were the topical corticosteroid of choice. The highest level of evidence score was given to clobetasol followed by budesonide with a lower evidence level. Conclusion All three topical corticosteroid preparations are effective for management of oral chronic GVHD with minimal easily avoided side effects.

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“…A multicentre questionnaire undertaken by Elad et al . ( 31 ) regarding the treatment of oral cGVHD showed that steroids were the first-line topical management of choice (91.7 %). The topical steroids budesonide (3mg/10ml) and dexamethasone (0.1mg/5ml) were the most commonly studied.…”

Section: Discussionmentioning

confidence: 99%

Management of oral Graft versus Host Disease with topical agents: A systematic review

Albuquerque

Khan²,

Poveda³

et al. 2016

Med Oral

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BackgroundOral Graft-versus-Host Disease (oGvHD) is a common complication of haematopoietic stem cell transplantation. Choosing the right topical application to be used intra orally can be a challenge. Consequently, the aim of this work is to review the effectiveness and safety of topical agents currently used in the management of the inflammatory mucosal lesions encountered in oGVHD.Material and MethodsWe carried out electronic searches of publications up to May 2015 of the databases Pubmed, National Library of Medicine’s Medline, Embase and the Cochrane Central Register of Controlled Clinical trials to identify potentially relevant studies (keywords: “oral”, “graft”, “versus”, “host”, “disease” and “treatment”). The main inclusion criterion was the reported use of a topical agent which was not intentionally swallowed when used for the treatment of oGVHD. A 3-point grading system, described by the Swedish Council on Technology Assessment in Health Care and the Centre for Reviews and Dissemination, University of York, was used to rate the methodological quality of the papers.ResultsFrom the 902 entries identified in the search, 7 studies qualifying for inclusion were analysed. Overall, there is limited evidence with regards to the effectiveness of topical steroids for oGVHD. However, the studies showed some effect of Budesonide alone and when combined with dexamethasone. Topical tacrolimus also appears to have some effect and clobetasol propionate mouthwash had a significantly better clinical response than dexamethasone mouthwash in treating oGVHD.ConclusionsAs the number of clinical trials conducted is limited, there is little evidence to support the use of topical therapies to treat the inflammatory mucosal lesions found in oGVHD. High quality randomised control trials are needed in order to measure the effectiveness of any topical application for the treatment of the inflammatory mucosal lesions found in oGVHD. Key words:Oral, graft versus host disease, topical, therapy.

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Clinical approach in the management of oral chronic graft-versus-host disease (cGVHD) in a series of specialized medical centers

Abstract: The responses described the common practices for oral cGVHD in several specialized centers across the world. The choice of topical treatments was influenced by the availability of medications in the provider's country.

Cited by 15 publications

References 46 publications

Dental Treatment in Patients with Leukemia

Dental Treatment in Patients with Leukemia

Efficacy and Safety of Topical Corticosteroids for Management of Oral Chronic Graft versus Host Disease

Management of oral Graft versus Host Disease with topical agents: A systematic review

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