A Review on Therapeutic Management for Oral Chronic Graft-versus-Host Disease

Abstract

Chronic graft-versus-host disease (cGVHD) is one of the main complications of transplantation in allogeneic hematopoietic cells which results in reduced quality of life. cGVHD mostly affects the oral cavity, producing various symptoms and manifestations. It can lead to both short- and long-term complications such as limited oral intake, mucosal sensitivity, secondary malignancy and even early death. GVHD is an alloimmune and autoimmune disorder with a variable clinical course that commonly involves various tissues and organs. It can occur in both the acute and chronic forms. In the case of cGVHD, a large number of organs are affected including the oral cavity. However, in some cases of cGVHD only the oral cavity gets affected. The clinical indications of chronic oral GVHD may include sclerosis, hyperkeratotic plaques, lichenoid lesions, and limited oral aperture. The level of oral involvement is commonly mild, but medium to high severity erosive as well as ulcerated lesions may also be occurred. Although diagnosed through clinical examination, its confirmation is usually done by biopsy study. The first treatment option is using local corticosteroids with the potency to treat half of patients. Extracorporeal photopheresis and systemic corticosteroids are in the next ranks. Patient survival after diagnosis of oral chronic GVHD is within 4.5 years in 50% of the cases, thus it is not regarded as a determinant factor in patient survival. This study attempted to provide a detailed approach for clinical diagnosis and management of patients suffered from oral cGVHD. It is particularly considered the factors such as differential diagnosis, symptom control, screening for and prevention of secondary complications. It has been tried to provide practical and relevant considerations and recommendations for all clinicians who dealswith oral cGVHD patients in order to achieve improved care and outcomes.