Graft-vs.-Host Disease

Woo, Sook Bin; Lee, Stephanie Joi; Schubert, Mark M.

doi:10.1177/10454411970080020701

Cited by 132 publications

(102 citation statements)

References 110 publications

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“…Of these, the most significant is chronic GVHD (cGVHD), which occurs in 40-70% of survivors of HCT and may involve the oral cavity as the principal or sole site of involvement, in 50-83% of those affected. 1 Oral cGVHD may present in many different ways, with 'diagnostic presentations' of oral cGVHD identified by the NIH consensus project (2005) as including oral mucosal cGVHD, salivary hypofunction and sclerodermatous-like fibrosis of the peri-oral tissues. Oral cGVHD may also be associated with other lesions, including mucoceles, candidosis and the development of muco-fibrous pseudo membranes.…”

Section: Introductionmentioning

confidence: 99%

Long-term oral complications of allogeneic haematopoietic SCT

Hull

Kerridge

Schifter

2011

Bone Marrow Transplant

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Section: Introductionmentioning

confidence: 99%

Long-term oral complications of allogeneic haematopoietic SCT

Hull

Kerridge

Schifter

2011

Bone Marrow Transplant

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“…6 The oral cavity may be the principal or sole site of involvement in 50-83% of those affected by cGVHD. 7 On a clinical basis, mucosal lesions, salivary gland dysfunction and taste disorders are similar to those of autoimmune disorders such as lichen planus, lupus and Sjö gren syndrome. [7][8][9] The typical histological findings of cGVHD in salivary glands are periductal and diffuse lobular lymphocyte infiltrate (CD8 þ over CD4 þ ), atrophy or destruction of acini, and fibrosis.…”

Section: Introductionmentioning

confidence: 99%

“…7 On a clinical basis, mucosal lesions, salivary gland dysfunction and taste disorders are similar to those of autoimmune disorders such as lichen planus, lupus and Sjö gren syndrome. [7][8][9] The typical histological findings of cGVHD in salivary glands are periductal and diffuse lobular lymphocyte infiltrate (CD8 þ over CD4 þ ), atrophy or destruction of acini, and fibrosis. 5,[10][11][12][13][14][15] Despite the advent of new therapies and management of cGVHD, minimal changes in this scenario have been observed, mainly due to an incomplete understanding of the pathogenesis of this disorder.…”

Section: Introductionmentioning

confidence: 99%

The impact of morphological and immunohistological changes in minor salivary glands on the health of the oral cavity in HSCT patients

Soares

Corrêa

Cintra

et al. 2013

Bone Marrow Transplant

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The objective of this study was to test the relationship between histological changes in minor salivary glands (MSG) and chronic GVHD (cGVHD) severity and OS of hematopoietic SCT (HSCT) patients, and to discriminate the participation of events preceding HSCT that damage MSG, from those linked to cGVHD. The MSG of 57 HSCT patients who were divided into two groups-oral cGVHD (36 cases) and non-cGVHD (21 cases)-were compared with the MSG of a control group of 19 non-HSCT individuals. cGVHD changes were assessed according to National Institutes of Health (NIH) consensus and the systems of Horn et al. Acinar areas and mononuclear cell subsets were set through morphometry. Horn's 'periductal lymphocytic infiltrate' correlated with an extensive form of cGVHD and NIH 'periductal lymphocytes with exocytosis into duct' correlated with global survival. Measurements of the acinar area differed between the three groups, being the lowest in cGVHD patients, but also reduced in non-cGVHD patients. Significant differences among CD45, CD45RO, CD4 and CD8 immunomarked cells/mm 2 were found by comparing the two groups of HSCT patients. In brief, periductal lymphocytic infiltrate and exocytosis implies inflammatory activity and, consequently, might reflect the cGVHD status and influence survival. Acini loss in non-cGVHD patients may be due to pre-transplant events, but massive lymphocyte infiltrate is part of the cGVHD process.

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“…5 Adjunctive treatments include oral hygiene to avert infection and measures to prevent complications of xerostomia (such as topical fluorides, saliva substitutes and sialogogues, that is, pilocarpine). 1 A low-energy laser was first reported to prevent radiation-induced mucositis in cancer patients. 6 A randomized trial with 30 patients found that the low-energy He/ Ne laser is capable of decreasing the severity and duration of oral mucositis associated with radiation therapy as well as reducing patient reports of oral pain.…”

mentioning

confidence: 99%

CO2 laser in oral graft-versus-host disease: a pilot study

Sharon

Shapira

et al. 2003

Bone Marrow Transplant

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Summary:This paper is the first to report the benefits of CO 2 laser treatment for pain control in severe oral chronic graftversus-host disease (GVHD). A CO 2 laser device was used during 17 treatment sessions in four patients. The CO 2 laser was applied over the mucosal lesions using 1 W for 2-3 s/1 mm 2 . This treatment resulted in a consistent and significant decrease in pain, measured using a standard visual analogue scale. These results suggest that the CO 2 laser can be used for the alleviation of pain in oral chronic GVHD. The treatment for GVHD usually involved first and second lines of treatments with systemic steroids, cyclosporine and azathioprine. However, oral GVHD is often refractory to systemic treatment, necessitating complementary topical treatment. Furthermore, when the oral mucosa is the solitary site of GVHD involvement, a topical approach may prevent the severe side effects associated with systemic treatments. There are several agents currently used topically for oral GVHD. These include palliative rinses, topical immunosuppressive agents (such as steroids, cyclosporine and azathioprine 1,3,4 ) and phototherapy. 5 Adjunctive treatments include oral hygiene to avert infection and measures to prevent complications of xerostomia (such as topical fluorides, saliva substitutes and sialogogues, that is, pilocarpine). 1 A low-energy laser was first reported to prevent radiation-induced mucositis in cancer patients. 6 A randomized trial with 30 patients found that the low-energy He/ Ne laser is capable of decreasing the severity and duration of oral mucositis associated with radiation therapy as well as reducing patient reports of oral pain. 6 Two recent pilot studies have shown the palliative effects of low-energy laser therapy for oral mucositis. 7,8 In these studies, lasers were operated in the milli-Watt range. The CO 2 laser that we selected allows treatments at higher power (1-10 W range).The potential of the CO 2 laser as a pain relief modality was initially reported in a small group of patients suffering from recurrent aphthous ulcers. 9 The palliative effects of the CO 2 laser have not been assessed for other mucosal lesions. Therefore, we speculated that the CO 2 laser can ease suffering from inflammatory lesions of oral chronic GVHD. The exact mechanism of the analgesic effect of the CO 2 laser is unknown. A possible explanation for this is that the CO 2 -laser-activated c-fibers induce a central somatosensory cortical response. 10 Conflicting evidence suggests that the CO 2 laser induces a spinal inhibitory effect via peripheral nerve stimulation. 11 The purpose of our pilot study was to evaluate the efficacy of the CO 2 laser to relieve severe pain caused by oral chronic GVHD. Patients and methodsA total of 17 laser treatments were provided to four HSCT patients (two males, two females) with severe painful oral chronic GVHD. All patients were hospitalized due to GVHD. During days prior to laser treatment, systemic analgesics (morphine and methadone) and local anesthetic mouthwashes (lid...

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Graft-vs.-Host Disease

Cited by 132 publications

References 110 publications

Long-term oral complications of allogeneic haematopoietic SCT

Long-term oral complications of allogeneic haematopoietic SCT

The impact of morphological and immunohistological changes in minor salivary glands on the health of the oral cavity in HSCT patients

CO2 laser in oral graft-versus-host disease: a pilot study

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