title: Salivary gland involvement in chronic graft-versus-host disease: prevalence, clinical significance, and recommendations for evaluation.
abstract: Although xerostomia is a commonly reported complaint in patients with chronic graft-versus-host disease (cGVHD), criteria for evaluating the prevalence and characteristics of salivary gland involvement have not been well defined in this patient population. Previous studies also have made no distinction between salivary and mucosal oral cGVHD. We systematically evaluated signs and symptoms of sicca in a large cohort of patients with cGVHD (n = 101) using instruments widely used to study Sjogren's syndrome. Xerostomia was reported in 60 (77%) patients reporting ocular and 52 (67%) patients reporting oral complaints [corrected]. The salivary flow rate was < or =0.2 mL/min in 27%, and < or =0.1 mL/min in 16%. Histopathological changes, consisting of mononuclear infiltration and/or fibrosis/atrophy, were present in all patients with salivary dysfunction. Importantly, there was no correlation of salivary and oral mucosal involvement in cGVHD. Patients with cGVHD-associated salivary gland involvement had diminished oral cavity-specific quality of life and lower body mass index. Salivary gland involvement is a common and clinically distinct manifestation of cGVHD. Formal evaluation of salivary function using standardized criteria is needed, and this could be incorporated as an outcome measure in clinical trials of cGVHD.
authors.affiliation: Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA. mimanguli@mail.nih.gov
authors.forename: Matin M
authors.initials: MM
authors.lastname: Imanguli
authors.forename: Jane C
authors.initials: JC
authors.lastname: Atkinson
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Mitchell
authors.forename: Daniele N
authors.initials: DN
authors.lastname: Avila
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Bishop
authors.forename: Edward W
authors.initials: EW
authors.lastname: Cowen
authors.forename: Manuel B
authors.initials: MB
authors.lastname: Datiles
authors.forename: Frances T
authors.initials: FT
authors.lastname: Hakim
authors.forename: David E
authors.initials: DE
authors.lastname: Kleiner
authors.forename: Michael C
authors.initials: MC
authors.lastname: Krumlauf
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pavletic
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000473:pathology*; D019337:Hematologic Neoplasms / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007765:Lacrimal Apparatus / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012469:Salivary Glands / Q000473:pathology*; D012470:Salivary Glands, Minor / Q000473:pathology; D012472:Salivation; D016037:Single-Blind Method; D013280:Stomatitis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D014985:Xerophthalmia / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D014987:Xerostomia / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D055815:Young Adult