Validation of the National Institutes of Health chronic GVHD Oral Mucosal Score using component-specific measures

Abstract

Oral chronic GVHD (cGVHD) is a common, late complication of alloSCT that is associated with significant patient morbidity. The NIH Oral Mucosal Score (NIH OMS) was developed to assess oral cGVHD therapeutic response, but has not been fully validated. This study’s purpose was to conduct a rigorous construct validity and internal consistency analysis of this score and its components (erythema, lichenoid, ulcers, mucoceles) using established measures of oral pain, oral function, oral-related quality-of-life, nutrition and laboratory parameters in 198 patients with cGVHD. The construct validity of the NIH OMS was supported: a moderate correlation was observed between NIH OMS and mouth pain (rho =0.43), while a weaker correlation was observed with low albumin (rho = −0.26). Total NIH OMS, erythema and lichenoid components were associated with malnutrition, oral pain and impaired oral QOL, while ulcers were only associated with oral pain. No associations were found between mucoceles and any indicator evaluated, including salivary function or xerostomia. Kappa determined between scale components was low overall (all ≤0.35), supporting a conclusion that each component measures a distinct manifestation of oral cGVHD. This study supports the use of the NIH OMS and its components (erythema, lichenoid and ulcerations) to measure clinician-reported severity of oral cGVHD.

Oral chronic graft-versus-host disease: A short review

“…The oral cavity is frequently involved, as the second most common site involved after skin due to HSCT, and oral manifestations occuring in 25 -90% of all cGVHD patients, often coexisting with cutaneous, hepatic or ocular cGVHD [2,7,9,[12][13][14][15][16]. It can be characterized as mucosal, salivary or sclerotic in nature, similary to several autoimmune conditions including Sjögren syndrome, oral lichen planus and scleroderma both clinical and histopathological presentation [12,13].…”

“…It can be characterized as mucosal, salivary or sclerotic in nature, similary to several autoimmune conditions including Sjögren syndrome, oral lichen planus and scleroderma both clinical and histopathological presentation [12,13].…”

“…Not readmitted (n=7) Reason for transplant HCV (4) Etoh/HCV (2) Other (2) HCV ( monitoring of oral cGVHD [3,12].…”

“…Chronic Graft-versus-host disease (cGVHD) is a major late complication of allo-HSCT, representing a clinical syndrome characterized by complex allogeneic and autoimmune dysregulation of the immune system, leading cause of non-relapse-related morbility and mortality among long-term transplant survivors [11,12]. It occurs in approximately 30-80% of long-term survivors of HSCT, either adults or children [2,3,11].…”

“…It may persist for several months or years, possibly affecting multiple organ systems including the skin, mouth, liver, eyes, lungs, joints, esophagus, and gastrointestinal and genitourinary tracts [2,11,12]. The skin and oral cavity are most commonly involved organs, and the diagosis is based on physical examination and biopsy findings [11,13].…”