title: Oral chronic graft-versus-host disease in pediatric patients after hematopoietic stem cell transplantation.
abstract: Chronic graft-versus-host disease (cGVHD) is a serious and potentially life-threatening complication of hematopoietic stem cell transplantation. This study, which is the largest single-center series of oral disease in pediatric patients with cGVHD, describes the oral findings in 49 consecutive patients seen in a pediatric multidisciplinary cGVHD clinic. All consecutive patients seen at the multidisciplinary pediatric hematopoietic stem cell transplantation/cGVHD clinic at the Dana-Farber Cancer Institute (Boston, MA) from July 2001 through October 2003 were included in this study. Subjective and objective assessments of mucosal, salivary gland, and sclerotic pathology were performed for each patient, and specific therapy was initiated when indicated. Oral mucosal cGVHD was identified in 22 (45%) of 49 patients. Only 4 (8%) of 49 patients reported mouth pain, and all patients reported being able to eat well. All patients who required specific therapy for their oral mucosal cGVHD (45%) were already taking at least 1 immunomodulatory agent; however, efficacy of treatment was difficult to assess because of inconsistent follow-up periods. Subjective and objective salivary gland and sclerotic disease were observed far less often. Oral mucosal pathology is common in these patients, and appropriate diagnosis and management of oral lesions is critical to reduce patient morbidity and to improve quality of life. The apparent lack of salivary gland involvement was notable. Developing validated age-appropriate evaluation strategies and identifying effective treatment guidelines will be invaluable in the future management of these patients.
authors.affiliation: Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA. ntreister@partners.org
authors.forename: Nathaniel S
authors.initials: NS
authors.lastname: Treister
authors.forename: Sook-Bin
authors.initials: SB
authors.lastname: Woo
authors.forename: Eileen W
authors.initials: EW
authors.lastname: O'Holleran
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Lehmann
authors.forename: Susan K
authors.initials: SK
authors.lastname: Parsons
authors.forename: Eva C
authors.initials: EC
authors.lastname: Guinan
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D017408:Guidelines as Topic; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008232:Lymphoproliferative Disorders / Q000473:pathology / Q000628:therapy*; D008297:Male; D009059:Mouth Diseases / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D009061:Mouth Mucosa / Q000473:pathology*; D012469:Salivary Glands / Q000473:pathology; D016511:Severe Combined Immunodeficiency / Q000628:therapy*