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Graft-versus-host disease (GvHD) of the tongue and of the oral cavity: a large retrospective study

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Abstract

Graft-versus-host disease (GvHD) causes severe mucositis, impairs feeding and favors infection. The objective of this study was to identify the impact of GvHD in the oral cavity. We reviewed all consecutive patients who developed oral GvHD after HSCT. The study period was over 14 years. 53 patients were identified. M/F = 1.4; median age was 48.6 years; the median follow-up was for up to 3 years and 6 months. Conditioning regimens included several drugs (e.g., busulfan, cyclophosphamide and fludarabine). In 11 cases, radiotherapy (RT) was also used. Patients treated with RT were more likely to have tooth decay requiring fillings (p = 0.029), to need canal root interventions (p = 0.005) and to have tartar requiring oral hygiene interventions (p = 0.011). Patients with a lymphoma diagnosis were more likely to develop perioral scleroderma and chronic oral GvHD (cGvHD) (p = 0.045). Oral acute GvHD (aGvHD) was seen in 26 patients (49.1%). 21 (39.6%) patients developed cGvHD. GvHD of the tongue was seen in 21 (40%) patients. Oral mucositis was seen in only 5 patients (9.4%). Conditioning regimens with RT are more likely to induce oral aGvHD. The tongue is often affected by GvHD.

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References

  1. Pavletic SZ, Fowler DH. Are we making progress in GVHD prophylaxis and treatment? Hematology / the Education Program of the American Society of Hematology. 2012, pp. 251–64.

  2. Blazar BR, Murphy WJ, Abedi M. Advances in graft-versus-host disease biology and therapy. Nat Rev Immunol. 2012;6:443–58.

    Article  Google Scholar 

  3. Gräf Saffig M, Klinikleitfaden. München: Urban & Fischer. 2012.

  4. Petersdorf E, Anasetti C, Servida P, Martin P, Hansen J. Effect of HLA matching on outcome of related and unrelated donor transplantation therapy for chronic myelogenous leukemia. Hematol Oncol Clin North Am. 1998;1:107–21.

    Article  Google Scholar 

  5. Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med. 2006;17:1813–26.

    Article  Google Scholar 

  6. Travnik R, Beckers M, Wolff D, Holler E, Landthaler M, Karrer S. Graft-versus-Host Disease (GvHD) - an update: Part 1: Pathophysiology, clinical features and classification of GvHD. Hautarzt. 2011;2:139–54.

    Article  Google Scholar 

  7. Ruutu T, Hermans J, van Biezen A, Niederwieser D, Gratwohl A, Apperley JF. How should corticosteroids be used in the treatment of acute GVHD? EBMT Chronic Leukemia Working Party. European Group for Blood and Marrow Transplantation. Bone Marrow Transpl. 1998;6:614–5.

    Article  Google Scholar 

  8. Mays JW, Fassil H, Edwards DA, Pavletic SZ, Bassim CW. Oral chronic graft-versus-host disease: current pathogenesis, therapy, and research. Oral Dis. 2013;4:327–46.

    Article  Google Scholar 

  9. Treister N, Duncan C, Cutler C, Lehmann L. How we treat oral chronic graft-versus-host disease. Blood. 2012;17:3407–18.

    Article  Google Scholar 

  10. Schubert MM, Correa ME. Oral graft-versus-host disease. Dent Clin North Am. 2008;1:79–109.

    Article  Google Scholar 

  11. Piccin A, Di Pierro AM, Canzian L, Primerano M, Corvetta D, Negri G, et al. Platelet gel: a new therapeutic tool with great potential. Blood Transfus. 2017;4:333–40.

    Google Scholar 

  12. Piccin A, Di Pierro AM, Tagnin M, Russo C, Fustos R, Corvetta D, et al. Healing of a soft tissue wound of the neck and jaw osteoradionecrosis using platelet gel. Regen Med. 2016;5:459–63.

    Article  Google Scholar 

  13. Piccin A, Di Pierro AM, Corvetta D, Canzian L, Gentilini I, Primerano M, et al. Severe skin radiodermatitis fully healed with the use of platelet gel and a hyperbaric chamber. Blood Transfus. 2015;6:552–4.

    Google Scholar 

  14. Piccin A, Rebulla P, Pupella S, Tagnin M, Marano G, Di Pierro AM, et al. Impressive tissue regeneration of severe oral mucositis post stem cell transplantation using cord blood platelet gel. Transfusion. 2017;9:2220–4.

    Article  Google Scholar 

  15. Curtis RE, Rowlings PA, Deeg HJ, Shriner DA, Socíe G, Travis LB, et al. Solid cancers after bone marrow transplantation. N Engl J Med. 1997;13:897–904.

    Article  Google Scholar 

  16. Jacobsohn DA. Novel therapeutics for the treatment of graft-versus-host disease. Expert Opin Investig Drugs. 2002;9:1271–80.

    Article  Google Scholar 

  17. Bassim CW, Fassil H, Dobbin M, Steinberg SM, Baird K, Cole K, et al. Malnutrition in patients with chronic GVHD. Bone Marrow Transpl. 2014;10:1300–6.

    Article  Google Scholar 

  18. Browning B, Thormann K, Seshadri R, Duerst R, Kletzel M, Jacobsohn DA. Weight loss and reduced body mass index: a critical issue in children with multiorgan chronic graft-versus-host disease. Bone Marrow Transpl. 2006;5:527–33.

    Article  Google Scholar 

  19. Jacobsohn DA, Margolis J, Doherty J, Anders V, Vogelsang GB. Weight loss and malnutrition in patients with chronic graft-versus-host disease. Bone Marrow Transpl. 2006;5:527–33.

    Google Scholar 

  20. Zauner C, Rabitsch W, Schneeweiss B, Schiefermeier M, Greinix HT, Ratheiser K, et al. Energy and substrate metabolism in patients with chronic extensive graft-versus-host disease. Transplantation. 2001;4:524–8.

    Article  Google Scholar 

  21. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11–48.

    Article  Google Scholar 

  22. Couriel D, Carpenter PA, Cutler C, Bolaños-Meade J, Treister NS, Gea-Banacloche J, et al. Ancillary therapy and supportive care of chronic graft-versus-host disease: national institutes of health consensus development project on criteria for clinical trials in chronic graft-versus-host disease:V. Ancillary Therapy and Supportive Care Working Group Report. Biol Blood Marrow Transpl. 2006;4:375–96.

    Article  Google Scholar 

  23. Bystricka E, Ghelase R, Gorican IK, Mazur E, Vokurka S, East Forum EBMT Nurses Group. Oral cavity care in patients after high-dose chemotherapy and stem cell transplantation: the East Forum EBMT Nurses Group standard of care. Bone Marrow Transpl. 2012;1:149–50.

    Article  Google Scholar 

  24. Fox PC. Salivary enhancement therapies. Caries Res. 2004;3:241–6.

    Article  Google Scholar 

  25. Wagner JL, Flowers ME, Longton G, Storb R, Schubert M, Sullivan KM. The development of chronic graft-versus-host disease: an analysis of screening studies and the impact of corticosteroid use at 100 days after transplantation. Bone Marrow Transpl. 1998;2:139–46.

    Article  Google Scholar 

  26. Rizzo JD, Wingard JR, Tichelli A, Lee SJ, Van Lint MT, Burns LJ, et al. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, the Center for International Blood and Marrow Transplant Research, and the American Society of Blood and Marrow Transplantation. Biol Blood Marrow Transpl. 2006;2:138–51.

    Article  Google Scholar 

  27. Dahllöf G, Modéer T, Bolme P, Ringdén O, Heimdahl A. Oral health in children treated with bone marrow transplantation: a one-year follow-up. ASDC J Dent Child. 1988;3:196–200.

    Google Scholar 

  28. Heimdahl A, Johnson G, Danielsson KH, Lönqvist B, Sundelin P, Ringden O. Oral condition of patients with leukemia and severe aplastic anemia. Follow-up 1 year after bone marrow transplantation. 5. Oral Medicine: Oral Surgery; 1985. pp. 498–504.

    Google Scholar 

  29. Liśniewska-Machorowska B, Ksiazek-Bak H, Pisulska-Otremba A. Assessment of the condition of the parodontium in children undergoing maxillary-orthopaedic treatment with reference to malocclusion, groups of teeth and duration of treatment with orthodontic devices. Czas Stomatol. 1990;9:567–72.

    Google Scholar 

  30. Meier JK, Wolff D, Pavletic S, Greinix H, Gosau M, Bertz H, et al. Oral chronic graft-versus-host disease: report from the international consensus conference on clinical practice in cGVHD. Clin oral investing. 2011; 2:127–39.

    Article  Google Scholar 

  31. Castellarin P, Stevenson K, Biasotto M, Yuan A, Woo SB, Treister NS. Extensive dental caries in patients with oral chronic graft-versus-host disease. Biol Blood Marrow Transpl. 2012;10:1573–9.

    Article  Google Scholar 

  32. Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet. 2009;9677:1798–807.

    Article  Google Scholar 

  33. Bozzetti F, Arends J, Lundholm K, Micklewright A, Zurcher G, Muscaritoli M. ESPEN. ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology. Clin Nutr. 2009;4:445–54.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Transfusion Service, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy

    Andrea Piccin, Cinzia Vecchiato & Ahmad Al-Khaffaf

  2. IMREST, Interdisciplinary Medical Research Center, Claudiana Scuola Superiore di Sanità Bolzano, Bolzano, Italy

    Andrea Piccin, Mario Tagnin, Cinzia Vecchiato, Ahmad Al-Khaffaf, Iris Agreiter, Giovanni Negri, Michael Kob, Angela Di Pierro, Fabio Vittadello, Guido Mazzoleni, Klaus Eisendle & Fabrizio Fontanella

  3. Department of Internal Medicine V, University of Innsbruck, Innsbruck, Austria

    Andrea Piccin

  4. Odontostomatology Service, San Maurizio Regional Hospital, Bolzano, Italy

    Mario Tagnin, Lisa Beqiri, Caroline Kaiser & Fabrizio Fontanella

  5. Division of Clinical Nutrition, San Maurizio Hospital, Bolzano, Italy

    Michael Kob

  6. Pathology Department, San Maurizio Regional Hospital, Bolzano, Italy

    Giovanni Negri & Guido Mazzoleni

Authors
  1. Andrea Piccin
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  2. Mario Tagnin
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  3. Cinzia Vecchiato
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  4. Ahmad Al-Khaffaf
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  5. Lisa Beqiri
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  8. Giovanni Negri
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  9. Michael Kob
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Correspondence to Andrea Piccin.

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Piccin, A., Tagnin, M., Vecchiato, C. et al. Graft-versus-host disease (GvHD) of the tongue and of the oral cavity: a large retrospective study. Int J Hematol 108, 615–621 (2018). https://doi.org/10.1007/s12185-018-2520-5

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  • DOI: https://doi.org/10.1007/s12185-018-2520-5

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