IADR Abstract Archives
Chronic Graft-versus-Host Disease Oral Mucosal Histopathological Grading Module
Objectives: Graft-versus-host disease (GvHD), the major complication in patients post hematopoietic stem cell transplantation. It can manifest as acute(a), chronic(c) or overlapping syndrome affecting multiple organs/sites. Oral complications arise in about 70% of patients, and include lichenoid-like reactions, restricted mouth opening and salivary gland dysfunction. Histopathological presentation is not well-defined and restricted to small cohorts. We aimed to define oral mucosa cGVHD histopathology and to develop and validate a scoring system in a large cohort to provide improved personalized understanding and diagnoses of this disease.
Methods: Oral mucosal cGvHD and overlapping syndrome biopsies were obtained from Karolinska University Hospital Biobank and Oral Medicine Clinic (n=100). Healthy and transplanted patients without clinical signs of GvHD were included as controls (n=40). Prominent re-occurring histological features were identified on stained sections (Hematoxylin and Eosin, Trichrome Masson and Periodic Acid Shiff) to establish the grading module (n≈30). Subsequently, the whole cohort were blindly graded by three independent researchers to validate the developed grading module.
Results: Identified histological features included extent of intra-epithelial lymphocytes and band-like inflammatory infiltrate, basement membrane thickening and clefting, flattening of rete ridges, clear cell number and basal cell vacuolisation. Together, these features were combined into points-based scoring system related to severity (graded 0=non-cGvHD to 3=most severe). In the current cohort, healthy non-GvHD tissues were accurately identified and cGvHD biopsies identified as predominantly grades 1 and 2 (mild and moderate).
Conclusions: The histopathological module provides a suitable platform to grade oral mucosal cGvHD. We highlight the importance of defined histopathological scoring that should be weighed against the clinical presentation to design individualised diagnoses for a complete oral cGvHD picture. Histological scoring related to clinical-severity will aid in the formulation of dynamic pathophysiological changes within oral mucosal cGVHD. Future implementation of adjunctive markers for abundant cells would support and highlight the individual grading variance amongst patients.
Methods: Oral mucosal cGvHD and overlapping syndrome biopsies were obtained from Karolinska University Hospital Biobank and Oral Medicine Clinic (n=100). Healthy and transplanted patients without clinical signs of GvHD were included as controls (n=40). Prominent re-occurring histological features were identified on stained sections (Hematoxylin and Eosin, Trichrome Masson and Periodic Acid Shiff) to establish the grading module (n≈30). Subsequently, the whole cohort were blindly graded by three independent researchers to validate the developed grading module.
Results: Identified histological features included extent of intra-epithelial lymphocytes and band-like inflammatory infiltrate, basement membrane thickening and clefting, flattening of rete ridges, clear cell number and basal cell vacuolisation. Together, these features were combined into points-based scoring system related to severity (graded 0=non-cGvHD to 3=most severe). In the current cohort, healthy non-GvHD tissues were accurately identified and cGvHD biopsies identified as predominantly grades 1 and 2 (mild and moderate).
Conclusions: The histopathological module provides a suitable platform to grade oral mucosal cGvHD. We highlight the importance of defined histopathological scoring that should be weighed against the clinical presentation to design individualised diagnoses for a complete oral cGvHD picture. Histological scoring related to clinical-severity will aid in the formulation of dynamic pathophysiological changes within oral mucosal cGVHD. Future implementation of adjunctive markers for abundant cells would support and highlight the individual grading variance amongst patients.