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Review
. 2019 Aug 1;2019(53):lgz007.
doi: 10.1093/jncimonographs/lgz007.

Oral Complications of Chronic Graft-Versus-Host Disease

Jane M Fall-Dickson  1 , Steven Z Pavletic  2 , Jacqueline W Mays  2 , Mark M Schubert  3
Affiliations
Review

Oral Complications of Chronic Graft-Versus-Host Disease

Jane M Fall-Dickson et al. J Natl Cancer Inst Monogr. .

Abstract

The increasing clinical indications for hematopoietic stem cell transplantation (HSCT) and improved clinical care throughout and following HSCT have led to not only long-term survival but also to an increasing incidence and prevalence of graft-versus-host disease (GVHD). Chronic GVHD (cGVHD) affects almost 50% of adult patients post-HSCT, with increasing incidence in pediatric patients as well. Oral cGVHD specifically has a reported prevalence ranging from 45% to 83% in patients who develop cGVHD and is more extensive in adult patients than in children. Oral cGVHD affects patients through clinically significant oral symptoms that may lead to significantly decreased caloric intake, oral infections, and increased health service utilization, and may thus affect overall health and survival. The most commonly used therapy for mucosal involvement of oral cGVHD is topical high-dose and ultra-high potency corticosteroids, and calcineurin inhibitors. This review of oral complications of cGVHD presents the clinical significance of oral cGVHD to HSCT survivors, our current understanding of the pathobiology of oral cGVHD and gaps in this evidence, and the global targeted interdisciplinary clinical research efforts, including the National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease. Current challenges regarding the management of oral cGVHD and strategies to advance our scientific understanding of this clinically significant chronic oral disease are presented.

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Figures

Figure 1.
Figure 1.
Erythema, lichen-like changes, and ulceration and pseudomembrane in adult patient with oral chronic graft-versus-host disease.
Figure 2.
Figure 2.
The National Institutes of Health oral chronic graft-versus-host disease clinical scoring instrument (form A, chronic graft-versus-host disease activity assessment-clinician report).
Figure 3.
Figure 3.
Pathobiology model of oral chronic graft-versus-host disease (Courtesy of Jacqueline W. Mays, DDS, MHSc, PhD, National Institute of Dental and Craniofacial Research, National Institutes of Health).
See this image and copyright information in PMC

References

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