Salivary gland involvement in chronic graft-versus-host disease: prevalence, clinical significance, and recommendations for evaluation

Abstract

Although xerostomia is a commonly reported complaint in patients with chronic graft-versus-host disease (cGVHD), criteria for evaluating the prevalence and characteristics of salivary gland involvement have not been well defined in this patient population. Previous studies also have made no distinction between salivary and mucosal oral cGVHD. We systematically evaluated signs and symptoms of sicca in a large cohort of patients with cGVHD (n = 101) using instruments widely used to study Sjogren's syndrome. Xerostomia was reported in 60 (77%) patients reporting ocular and 52 (67%) patients reporting oral complaints [corrected]. The salivary flow rate was < or =0.2 mL/min in 27%, and < or =0.1 mL/min in 16%. Histopathological changes, consisting of mononuclear infiltration and/or fibrosis/atrophy, were present in all patients with salivary dysfunction. Importantly, there was no correlation of salivary and oral mucosal involvement in cGVHD. Patients with cGVHD-associated salivary gland involvement had diminished oral cavity-specific quality of life and lower body mass index. Salivary gland involvement is a common and clinically distinct manifestation of cGVHD. Formal evaluation of salivary function using standardized criteria is needed, and this could be incorporated as an outcome measure in clinical trials of cGVHD.

Figure 1

A - Photomicrograph of a salivary gland that shows Sjogren’s like periductal inflammation. There is a periductal infiltrate composed predominantly of lymphocytes (H&E, 200x). B - Severe atrophy with interstitial fibrosis. Most of the mucinous acinar parenchyma has been lost from this lobule, replaced by ductular metaplasia and increased peri-lobular adipose tissue. There is a mild, predominant lymphocytic infiltrate in the fibrous interstitium. (H&E, 200x)