17 - Oral Chronic Graft versus Host Disease

Summary

INTRODUCTION

The oral cavity is a frequent target of chronic graft versus host disease (cGVHD) with changes observed in the lips, muscles, mucosa, salivary glands, dentition, and also in the facial skin. When severe, oral cGVHD is functionally debilitating; however, even mild involvement can have a significant impact on the conduct of daily activities and overall quality of life (QOL). Early recognition and diagnosis of oral changes, provision of appropriate and effective therapies, and vigilant long-term follow-up are critical to minimize complications and to improve both short- and long-term outcomes.

INCIDENCE

Oral cGVHD is a frequent and, often, very prominent complication following allogeneic hematopoietic cell transplantation (HCT). Almost 80% of patients diagnosed with cGVHD demonstrate some degree of oral involvement, making this one of the most common clinical manifestations. In fact, the prevalence of oral and skin cGVHD is nearly equivalent, making these the two most commonly affected tissues. Although a number of risk factors for the development of cGVHD have been characterized, none specific for the oral cavity have been identified. Standard GVHD prophylaxis regimens are the only specific measures that can prevent or minimize the risk of developing oral cGVHD.

Although oral findings may be the initial and in some cases only indication of cGVHD development, this is highly variable and oral changes may occur at any point along the course of evolution of cGVHD. Also, oral cGVHD may first present clinically as other areas (e.g., skin) are resolving.