A comparison of oral graft vs. host disease (GVHD) between nonmyeloablative stem cell transplantation (NST) and myeloablative hematopoietic stem cell transplantation (HSCT)

Abstract

In recent years the nonmyeloablative stem cell transplantation (NST) became a common hematopoietic stem cell transplantation (HSCT) conditioning protocol. The NST is based on the concept that graft vs. leukemia (GVL) effect will compensate for the nonablation and the ablation-related toxicities will be avoided. The objective of this study was to evaluate the oral prevalence and manifestations of acute graft versus host disease (aGVHD) in patients undergoing NST compared to patients undergoing myeloablative HSCT. A prospective longitudinal study including 32 patients undergoing HSCT was undertaken. Patients were classified into 3 groups: NST, ablative HSCT, and autologous HSCT (used as a control group). Oral tissues were examined once every 3 weeks, starting 2 weeks post-HSCT and ending on day 100 post-HSCT. Clinical signs typical to oral GVHD were documented. The examiner was blinded in regard to patient classification. Comparison of systemic GVHD incidence and oral GVHD incidence was done using Pearson's chi-square test and Fisher's exact test. The incidence of oral GVHD was 29.4% in the NST group and 75% in the myeloablative HSCT group (P<.08). The mean onset time of oral GVHD was 17 days post-HSCT in the NST group and 21.5 days post-HSCT in the myeloablative HSCT group (P<.76). There were no patients with systemic or oral GVHD in the autologous HSCT control group. There is a trend for a decreased incidence of oral involvement typical for aGVHD in NST compared to myeloablative HSCT. Large-scale studies are warranted to confirm this result.