Graft-versus-host disease affecting oral cavity. A review

Abstract

Graft versus host disease (GVHD) is one of the most frequent and serious complications of hematopoietic stem cell transplantation, and is regarded as the leading cause of late mortality unrelated to the underlying malignant disease. GVHD is an autoimmune and alloimmune disorder that usually affects multiple organs and tissues, and exhibits a variable clinical course. It can manifest in either acute or chronic form. The acute presentation of GVHD is potentially fatal and typically affects the skin, gastrointestinal tract and liver. The chronic form is characterized by the involvement of a number of organs, including the oral cavity. Indeed, the oral cavity may be the only affected location in chronic GVHD. The clinical manifestations of chronic oral GVHD comprise lichenoid lesions, hyperkeratotic plaques and limited oral aperture secondary to sclerosis. The oral condition is usually mild, though moderate to severe erosive and ulcerated lesions may also be seen. The diagnosis is established from the clinical characteristics, though confirmation through biopsy study is sometimes needed. Local corticosteroids are the treatment of choice, offering overall response rates of close to 50%. Extracorporeal photopheresis and systemic corticosteroids in turn constitute second line treatment. Oral chronic GVHD is not considered a determinant factor for patient survival, which is close to 52% five years after diagnosis of the condition. Key words:Chronic graft-versus-host disease, oral chronic graft-versus-host disease, pathogenics, management, survival.

Oral manifestations of autoinflammatory and autoimmune diseases

“…After transplantation, it may happen that, due to various risk factors, donor T-cells attack antigens on the recipient cells. The resulting immune reaction leads to impairment of various tissues (55). Perhaps autoimmunity is also involved (2).…”

“…Perhaps autoimmunity is also involved (2). Based on clinical presentation, two categories of the disease are known: acute and chronic (55). The next two paragraphs of this article focus on oral chronic GVHD.…”

“…Affected individuals typically report worse symptoms than clinicians would expect based on the clinical signs. However, oral features do not affect patient survival, but may still exist after changes in other tissues subside (55,56). A potential oral squamous cell carcinoma occurrence has also been reported; hence patients should be repeatedly monitored (2).…”

Pre-transplant arm muscle area: a simple measure to identify patients at risk

“…It can manifest in either acute or chronic form. The acute presentation of GVHD is potentially fatal and typically affects the skin, gastrointestinal tract, and liver [7].…”

Leukoplakia of the Marginal Gingiva: A Report of Two Cases

“…The preceding hematopoietic cell transplantation for λ-light chain multiple myeloma in case 2 could be suggestive of chronic graft versus host disease, but this is unusual after autologous transplantation and presents with extensive lesions that resemble oral lichen planus. 7 PVL is common on the gingivae, 3 and PVL of the gingivae (PVLG) is described as a subset of PVL that preferen-tially involves the anterior gingivae. 4 PVLG may present as solitary, non-descript white plaque on the marginal gingiva of a single tooth, but in 10 of 11 cases described, there was involvement of more than one tooth, as "linear gingival hyperplasia".…”