Abstract
Graft versus host disease (GVHD) is one of the most frequent and serious complications of hematopoietic stem cell transplantation, and is regarded as the leading cause of late mortality unrelated to the underlying malignant disease. GVHD is an autoimmune and alloimmune disorder that usually affects multiple organs and tissues, and exhibits a variable clinical course. It can manifest in either acute or chronic form. The acute presentation of GVHD is potentially fatal and typically affects the skin, gastrointestinal tract and liver. The chronic form is characterized by the involvement of a number of organs, including the oral cavity. Indeed, the oral cavity may be the only affected location in chronic GVHD. The clinical manifestations of chronic oral GVHD comprise lichenoid lesions, hyperkeratotic plaques and limited oral aperture secondary to sclerosis. The oral condition is usually mild, though moderate to severe erosive and ulcerated lesions may also be seen. The diagnosis is established from the clinical characteristics, though confirmation through biopsy study is sometimes needed. Local corticosteroids are the treatment of choice, offering overall response rates of close to 50%. Extracorporeal photopheresis and systemic corticosteroids in turn constitute second line treatment. Oral chronic GVHD is not considered a determinant factor for patient survival, which is close to 52% five years after diagnosis of the condition. Key words:Chronic graft-versus-host disease, oral chronic graft-versus-host disease, pathogenics, management, survival.
Highlights
Before transplantation, the recipient is subjected to myelosuppressive and immunosuppressive conditioning treatments in order to ensure that the recipient immune system is reconstructed after grafting from the donor cells, thereby avoiding rejection problems
The aim of the present study is to offer a practical update on oral chronic graft versus host disease (GVHD), fundamented on what we consider to be five key concerns in relation to this disease: (a) What are the risk factors for cGVHD and what is the pathogenic role of the T cells? (b) How often is the oral cavity affected in cGVHD? (c) In what cases would a biopsy be indicated to confirm the diagnosis of oral cGVHD? (d) Is the treatment of oral cGVHD effective? Does it depend on any known factor? (e) How does oral cGVHD evolve? A Medline-PubMed and Cochrane Collaboration literature search was conducted to clarify these issues
How often is the oral cavity affected in cGVHD? the epidemiological information referred to GVHD is not homogeneous, it has been estimated that almost one-half of all patients subjected to hematopoietic stem cell transplantation will develop the disease [4,7]
Summary
The recipient is subjected to myelosuppressive and immunosuppressive conditioning treatments in order to ensure that the recipient (host) immune system is reconstructed after grafting from the donor (graft) cells, thereby avoiding rejection problems. The immunocompetent T lymphocytes of the donor may recognize as foreign the antigens expressed by the recipient cells - thereby triggering an immune reaction accompanied by intense inflammatory responses that result in damage to different organs and tissues of the recipient. This condition is known as graft versus host disease (GVHD), and is a consequence of the incompae138. The criteria that define and characterize the different forms of presentation of GVHD are shown in figure 1 and in table 1
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