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Review
. 2008 Jul;14(5):396-412.
doi: 10.1111/j.1601-0825.2008.01448.x.

Oral graft-versus-host disease

M M Imanguli  1 , I Alevizos, R Brown, S Z Pavletic, J C Atkinson
Affiliations
Review

Oral graft-versus-host disease

M M Imanguli et al. Oral Dis. 2008 Jul.

Abstract

Objective: Graft-versus-host disease (GVHD) is a leading cause of morbidity and mortality in patients receiving hematopoietic cell transplant. It is estimated that 40-70% of engrafted patients surviving the initial transplant eventually develop chronic GVHD (cGVHD), which can persist for months to years and require long-term management from multiple disciplines. This review describes the oral component of this transplant complication.

Design: The search related to GVHD patho-biology, salivary gland disease after hematopoietic cell transplant and treatments for oral GVHD encompassed literature from 1966 through 2008. Searches were limited to the MEDLINE/PubMed database and English language literature in peer-reviewed journals.

Results: Our understanding of the patho-biology of oral cGVHD is based on studies of other affected tissues. It is difficult to determine the prevalence and incidence of salivary gland disease after transplant because there is no universally accepted case definition. In general, clinical trials for treatment of oral cGVHD have been too small to make strong recommendations for use in clinical practice.

Conclusions: Larger well-designed clinical studies are needed to understand the patho-biology of oral cGVHD and determine best treatments for this disease.

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Figures

Figure 1
Figure 1
Similarities in clinical picture of oral cGVHD and oral lichen planus. Ulcerative and erythematous lesions of the buccal mucosa in oral cGVHD (a) and lichen planus (b)
Figure 2
Figure 2
Histopathologic changes of oral cGVHD. Note “dyskeratotic’ (apoptotic) keratinocyte and adjacent lymphocyte (small arrow) and subepithelial mononuclear infiltrate (large arrow).
Figure 3
Figure 3
Immunohistology of oral cGVHD. Immunofluorescent staining and confocal imaging for CD3 (red, a), CD8 (cyan, b), and CD45RO, a marker for effector-memory T cells (green, c). Nuclei are stained with DAPI, blue. Note predominance of CD8 cells in the infiltrate (overlap, d). Line shows the approximate position of the basement membrane.
See this image and copyright information in PMC

References

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