Abstract
PurposeSymptoms of oral chronic graft-versus-host-disease (cGVHD) may significantly affect the oral health–related quality of life (OHRQoL). This study aimed to assess the OHRQoL in patients with oral cGVHD and to examine whether oral cGVHD symptoms, mucosal cGVHD, and salivary gland function correlated with OHRQoL.MethodsPatients referred to the oral cGVHD outpatient clinic were included. Severity of oral mucosal cGVHD, oral cGVHD symptoms, and OHRQoL was assessed by the NIH OMS, NIH OSS, and OHIP-14, respectively. Unstimulated and stimulated whole salivary flow rates were determined and categorized into “hyposalivation,” “normal salivary flow,” and “hypersalivation.”ResultsOf 56 included patients, 80% had mild, moderate, or severe oral mucosal cGVHD. Mean total score of OHRQoL was 16.5 (±11.7), negatively affected by functional problems. Patients reported highest scores regarding oral sensitivity and xerostomia. Significant correlations were found between severity of oral pain and OHRQoL and between oral sensitivity and OHRQoL. No correlation was found between oral mucosal cGVHD and OHRQoL. Patients with hyposalivation, normal salivary flow, and hypersalivation reported equal levels of OHRQoL.ConclusionResults demonstrate that the OHRQoL was mostly negatively affected by complaints of oral pain and oral sensitivity and less by the severity of oral mucosal cGVHD assessed by the NIH OMS score. Special attention of (oral) health care professionals for patients with oral cGVHD is mandatory to alleviate their symptoms and improve OHRQoL.
Highlights
Hematopoietic stem cell transplantation (HSCT) is a widely used intervention to treat malignancies and other disorders of the hematopoietic system
The severity of oral mucosal chronic graft-versus-host disease (GVHD) (cGVHD) was assessed by a specialized dentist (JR-D), and patients were asked to fill out questionnaires about oral cGVHD symptoms and oral health–related quality of life (OHRQoL)
To assess the OHRQoL, patients were asked to complete the Dutch version of the Oral Health Impact Profile-14 (OHIP-14)
Summary
Hematopoietic stem cell transplantation (HSCT) is a widely used intervention to treat malignancies and other disorders of the hematopoietic system. The numbers of HSCTs performed continue to rise with more than 45,000 transplants reported in Europe in 2017, of which 18,281 were allogeneic HSCT (with donor-derived cells) [1]. Whereas acute GVHD typically presents specific clinical and histopathological features of the skin, liver, and/or gastrointestinal mucosa, chronic GVHD is defined as a systemic disease with multiorgan involvement, affecting the skin, mouth, genitals, eyes, liver, or lungs, presenting a wide range of signs and symptoms [5, 9,10,11]. The 5-year non-relapse mortality rate of cGVHD ranges from 5 to 70% depending on factors such as prior acute GVHD, time between transplantation and development of cGVHD, donor type, and gender mismatch [12]
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