Abstract
ABSTRACTObjective The aim of this study was to evaluate patients with complete response of oral chronic graft-versus-host disease to immunosuppressive treatment.Methods A total of 29 patients submitted to allogeneic hematopoietic stem cell transplantation, with oral chronic graft-versus-host disease, were enrolled in this retrospective study, from September 2012 to February 2018. Patients were treated with combined topical dexamethasone solution and topical tacrolimus ointment, combined topical dexamethasone and topical tacrolimus, systemic immunosuppressive medication, and topical dexamethasone only.Results The mean time of complete response of lichenoid lesions, erythema, and ulcers using dexamethasone and systemic immunosuppressive medication was of 105, 42 and 42 days, respectively (p=0.013).When we associated dexamethasone, tacrolimus and systemic immunosuppressive medication, the mean time of complete response of lichenoid lesions, erythema and ulcers was of 91,84 and 77 days (p=0.011). When dexamethasone was used alone, the mean time of complete response of lichenoid lesions, erythema and ulcers was 182, 140, 21 days, respectively (p=0.042).Conclusion Our study shows that lichenoid lesions require more time to heal. Notably, lichenoid lesions tend to respond better to dexamethasone combined with tacrolimus and systemic immunosuppressive medication, whereas erythema and ulcers respond better to dexamethasone combined with systemic immunosuppressive medication and dexamethasone only, respectively.
Highlights
Chronic graft-versus-host disease is one of the main complications of hematopoietic stem cell transplantation (HSCT). This condition affects 30% to 70% of patients, leading to inflammatory responses in different organs and tissues that look like autoimmune diseases.[1]. In the oral cavity, the clinical symptoms of cGvHD are mainly related to the mucosa and tongue, and are characterized by the presence of lichenoid lesions in the oral mucosa, which are recognized by the National Institutes of Health (NIH) consensus as diagnostic lesions
Despite the absence of strong evidence, some studies show that most patients with oral cGvHD taking dexamethasone combined with tacrolimus respond positively to treatment.[9,10] In the present observational study, we sought to assess patients with complete response to treatment with topical immunosuppression with oral cGvHD, associated or not with systemic immunosuppression
This study collected data from patient medical records to evaluate the complete response of oral cGvHD to dexamethasone, with or without tacrolimus, with or without systemic immunosuppression
Summary
Chronic graft-versus-host disease (cGvHD) is one of the main complications of hematopoietic stem cell transplantation (HSCT). This condition affects 30% to 70% of patients, leading to inflammatory responses in different organs and tissues that look like autoimmune diseases.[1] In the oral cavity, the clinical symptoms of cGvHD are mainly related to the mucosa and tongue, and are characterized by the presence of lichenoid lesions in the oral mucosa (white streaks), which are recognized by the National Institutes of Health (NIH) consensus as diagnostic lesions. Despite the absence of strong evidence, some studies show that most patients with oral cGvHD taking dexamethasone combined with tacrolimus respond positively to treatment.[9,10] In the present observational study, we sought to assess patients with complete response to treatment with topical immunosuppression with oral cGvHD, associated or not with systemic immunosuppression The last NIH consensus[5] recommends topical treatment with high-potency corticosteroids, calcineurin inhibitors and analgesics.[6,7] Local topical medicines have the benefit of intensifying treatment, reducing or eliminating symptoms without increasing systemic immunosuppression.[8,9] Topical treatments may provide better local benefits than systemic therapy alone.[5]
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