Immunohistopathological study of the oral lichenoid lesions of chronic GVHD

Sato, Miki; Tokuda, Nobuko; Fukumoto, Tetsuo; Mano, Takamitsu; Satō, Tsugitaka; Ueyama, Yoshiya

doi:10.1111/j.1600-0714.2005.00372.x

Cited by 49 publications

(59 citation statements)

References 16 publications

(24 reference statements)

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“…These extraoral sites are similar to those found in the extraoral sites of autoimmune disorders with oral findings clinically similar to those found in cGVHD, as suggested by lichen planus, Sjögren's syndrome, and scleroderma. Oral lichen planus is a chronic inflammatory autoimmune disease that affects the oral mucosa, with a clinical presentation very similar to that of clinically active oral mucosal cGVHD, and which has been used as a comparative disease entity for cGVHD (Sato et al 2006;Pimentel et al 2010). It has a prevalence of 0.1 to 4%, and, like oral cGVHD, may be a risk factor for oral squamous cell carcinoma (Liu et al 2010).…”

Section: Discussionmentioning

confidence: 99%

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Oral Disease Profiles in Chronic Graft versus Host Disease

et al. 2015

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At least half of patients with chronic graft-versus-host-disease (cGVHD), the leading cause of morbidity and non-relapse mortality after allogeneic stem cell transplantation, have oral manifestations: mucosal lesions, salivary dysfunction, and limited mouth-opening. cGVHD may manifest in a single organ or affect multiple organ systems, including the mouth, eyes, and the skin. The interrelationship of the 3 oral manifestations of cGVHD with each other and with the specific manifestations of extraoral cGVHD has not been studied. In this analysis, we explored, in a large group of patients with cGVHD, the potential associations between: (1) oral mucosal disease and erythematous skin disease, (2) salivary gland dysfunction and lacrimal gland dysfunction, and (3) limited mouth-opening and sclerotic skin cGVHD. Study participants, enrolled in a cGVHD Natural History Protocol (NCT00331968, n = 212), underwent an oral examination evaluating: (1) mucosal cGVHD [NIH Oral Mucosal Score (OMS)], (2) salivary dysfunction (saliva flow and xerostomia), and (3) maximum mouth-opening measurement. Parameters for dysfunction (OMS > 2, saliva flow ≤ 1 mL/5 min, mouth-opening ≤ 35 mm) were analyzed for association with skin cGVHD involvement (erythema and sclerosis, skin symptoms), lacrimal dysfunction (Schirmer’s tear test, xerophthalmia), Lee cGVHD Symptom Scores, and NIH organ scores. Oral mucosal disease (31% prevalence) was associated with skin erythema ( P < 0.001); salivary dysfunction (11% prevalence) was associated with lacrimal dysfunction ( P = 0.010) and xerostomia with xerophthalmia (r = 0.32, P = 0.001); and limited mouth-opening (17% prevalence) was associated with skin sclerosis ( P = 0.008) and skin symptoms ( P = 0.001). There was no association found among these 3 oral cGVHD manifestations. This analysis supports the understanding of oral cGVHD as 3 distinct diseases: mucosal lesions, salivary gland dysfunction, and mouth sclerosis. Clear classification of oral cGVHD as 3 separate manifestations will improve clinical diagnosis, observational research data collection, and the definitions of outcome measures in clinical trials.

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Section: Discussionmentioning

confidence: 99%

“…Lichen planus manifests as oral mucosal disease with a spectrum of changes similar to those seen in oral mucosal cGVHD (Sato et al 2006;Pimentel et al 2010). Sjögren's syndrome causes salivary dysfunction, similar to the dry mouth seen in salivary gland cGVHD, though the pathology differs (Lawley et al 1977;Sale et al 1981).…”

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confidence: 99%

Oral Disease Profiles in Chronic Graft versus Host Disease

et al. 2015

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“…Retrospective case studies of biopsies performed for clinical indications have been accompanied by minimal patient information and have relied for controls on tissues from healthy donors, not non-GVHD transplant recipients. 6,7 The limited understanding of disease pathogenesis has restricted the development of new therapies for cGVHD. Current treatment of cGVHD continues to focus on nonspecific immunosuppression, resulting in exacerbation of immune deficits, infectious complications, and tumor relapse.…”

Section: Introductionmentioning

confidence: 99%

Increased T-bet+ cytotoxic effectors and type I interferon–mediated processes in chronic graft-versus-host disease of the oral mucosa

Imanguli

Swaim

League

et al. 2009

Blood

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Although chronic graft-versus-host disease (cGVHD) is a major long-term complication of allogeneic hematopoietic stem cell transplantation, little is known of its pathogenesis. We have systematically examined oral mucosa among cGVHD patients and determined that the clinical severity of oral cGVHD was correlated with apoptotic epithelial cells, often found adjacent to infiltrating effector-memory T cells expressing markers of cytotoxicity and type I cytokine polarization. Accumulation of T-bet ؉ T-cell effectors was asso-

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“…7 Histologically, the observed interface dermatitis of C-GVHD with a junctional CD8 ϩ cell infiltrate is very reminiscent of that which is observed in LP. 8 The benefit of rituximab therapy for C-GVHD is now well established, 9,10 Although less reminiscent of an LP inflammatory infiltrate, an interface dermatitis is usually observed in systemic lupus erythematosus and refractory dermatomyositis, which have also responded to rituximab. Since the inflammatory infiltrate in LP is composed of T cells (with a predominance of CD8 ϩ over CD4 ϩ ), the mechanism of action of rituximab, which targets CD20, a B-cell-specific membrane marker, is challenging to explain.…”

Section: Commentmentioning

confidence: 99%