IADR Abstract Archives
Clinical and Diagnostic Management of Oral Chronic Graft-Versus-Host Disease
Objectives: Oral chronic Graft-versus-host disease (cGVHD) is a significant complication in patients after allogenic hematopoietic cell transplantation (HCT). In this study we are performing a large prospective cohort study of HCT patients for clinical oral cGVHD development and diagnosis.
Methods: Patients are consecutively recruited pre-HCT and followed-up at 6, 12, and 24 months after transplantation. Prior-HCT, patient-reported assessment was performed using Oral Mucositis Daily Questionnaire assessment tool and Journal of American Dental Association xerostomia scale. At each study visit post-HCT, patients were diagnosed according to the National Institutes of Health (NIH) oral and overall staging criteria, oral medicine activity was performed using the NIH Oral Mucosa Rating Scale and patient self-assessment including the Lee Symptom Scale. Oral medicine specialists were clinically aligned using ten training cases. Overall cGVHD-reported activity and therapeutic intensity was performed by hematologists using the NIH cGVHD scale. Each patient was asked for unstimulated saliva, maximum mouth opening and two oral mucosal samples. Histopathology grade was assessed by Hematoxylin and Eosin, Periodic Acid Schiff and van Gieson. Immunohistochemistry was performed to examine B- and T-cells, and Antigen-presenting cells. The patient demographics were analyzed in correlation to clinical and histological findings.
Results: The clinical study is ongoing. At baseline and follow-up, substantial intra- and inter-rater oral medicine grading agreement was apparent. 90 patients have been recruited to date; 52 have been assessed at 6 months, 32 at 12 months and 19 at 24-months. Saliva samples have been taken at most visits (192) and 46 mucosal samples have been obtained. Data analysis reveals clear distinctions between the clinical and histological findings, demonstrating subclinical disease activity in clinically healthy patients post-HCT.
Conclusions: This is a unique longitudinal study combining clinical findings with histopathological features to aid in the understanding of the underlying mechanisms and disease progression for oral cGVHD patients.
Methods: Patients are consecutively recruited pre-HCT and followed-up at 6, 12, and 24 months after transplantation. Prior-HCT, patient-reported assessment was performed using Oral Mucositis Daily Questionnaire assessment tool and Journal of American Dental Association xerostomia scale. At each study visit post-HCT, patients were diagnosed according to the National Institutes of Health (NIH) oral and overall staging criteria, oral medicine activity was performed using the NIH Oral Mucosa Rating Scale and patient self-assessment including the Lee Symptom Scale. Oral medicine specialists were clinically aligned using ten training cases. Overall cGVHD-reported activity and therapeutic intensity was performed by hematologists using the NIH cGVHD scale. Each patient was asked for unstimulated saliva, maximum mouth opening and two oral mucosal samples. Histopathology grade was assessed by Hematoxylin and Eosin, Periodic Acid Schiff and van Gieson. Immunohistochemistry was performed to examine B- and T-cells, and Antigen-presenting cells. The patient demographics were analyzed in correlation to clinical and histological findings.
Results: The clinical study is ongoing. At baseline and follow-up, substantial intra- and inter-rater oral medicine grading agreement was apparent. 90 patients have been recruited to date; 52 have been assessed at 6 months, 32 at 12 months and 19 at 24-months. Saliva samples have been taken at most visits (192) and 46 mucosal samples have been obtained. Data analysis reveals clear distinctions between the clinical and histological findings, demonstrating subclinical disease activity in clinically healthy patients post-HCT.
Conclusions: This is a unique longitudinal study combining clinical findings with histopathological features to aid in the understanding of the underlying mechanisms and disease progression for oral cGVHD patients.