Oral chronic GVHD after allogeneic stem cell transplantation without total body irradiation performed at a young age

Kristine Eidal Tanem,Petter Wilberg,Phoi Phoi Diep,Ellen Ruud,Bente Brokstad Herlofson,Anne B Skaare,Lorentz Brinch

doi:10.1007/s00520-022-06836-7

Kristine Eidal Tanem, Petter Wilberg + Show 5 more

Open Access

https://doi.org/10.1007/s00520-022-06836-7

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Abstract

PurposeLong-term survivors (LTSs) of allogeneic hematopoietic stem cell transplantation (allo-HCT) may experience oral long-term effects like chronic graft-versus-host disease (oral cGVHD). The aim of this study was to investigate oral cGVHD in patients treated at a young age (< 30 years) more than 5 years after allo-HCT without total body irradiation (TBI).MethodsAll 94 participants went through a semi-structured interview, and an oral examination. Diagnosis of oral cGVHD was based on the “National Institutes of Health (NIH) cGVHD diagnosis and staging consensus criteria” from 2014.ResultsMean age at transplantation was 17.5 years (range 0.4–29.9 years), and mean time since transplantation was 16.7 years (range 6–26 years). Oral cGVHD was diagnosed in 26 (28%) of 94 LTSs. Of which 20 (21.5%) showed lichen planus-like (LPL) changes, and additionally six (6.5%) also fulfilled the diagnostic criteria of oral cGVHD since they had one or more distinctive signs and symptoms of oral cGVHD combined with definite cGVHD in another organ. No LTSs reported oral cGVHD (NIH) grade 3. There was a significant association between cGVHD in the oral cavity and cGVHD in another organ (77% vs 29%, p < 0.001). Out of 72 LTSs, who answered the questions regarding taste disturbances, 16 (22%) reported dysgeusia. No LTSs developed secondary malignancies in the oral cavity during follow-up time.ConclusionOral long-term effects, such as oral cGVHD, may persist for many years after allo-HCT without TBI-conditioning in patients treated at a young age.

Highlights

Allogeneic hematopoietic cell transplantation is a potentially curative treatment for both malignant and non-malignant hematopoietic diseases [1]
The aim of the present study was to investigate the prevalence, symptoms, and characteristics of oral chronic graft-versushost disease (cGVHD) in patients treated at a young age (< 30 years at transplantation) more than 5 years after allo-HCT without total body irradiation (TBI)
The present study showed that 26 (28%) long-term survivors (LTSs) fulfilled the criteria of oral cGVHD [4]

Summary

Introduction

Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment for both malignant and non-malignant hematopoietic diseases [1]. In Norway, the conditioning regimen used has mainly been based upon myeloablative chemotherapy without total body irradiation (TBI). This is in contrast to other traditional protocols that include TBI [1]. Even though the survival rate has increased since the first allo-HCT in the 1950s [1], long-term survivors (LTSs) may experience severe late morbidity after transplantation [3]. The most significant late effect is chronic graft-versushost disease (cGVHD) [4]. It is an inflammatory condition, where donor lymphocytes respond to the patient’s antigens resulting in immunological reactions [5] affecting mainly

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