1
|
Bhattarai A, Shah S, Yadav R, Dhakal G, Neupane R, Paudel S, Bhandari P, Abu Serhan H, Sah R, Sah S, Barboza JJ. Diagnostic and prognostic role of elafin in skin acute graft versus host disease: a systematic review. Hematology 2024; 29:2293497. [PMID: 38112182 DOI: 10.1080/16078454.2023.2293497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Graft versus host disease (GVHD) is the common complication seen after allogeneic hematopoietic stem cell transplantation (HSCT) and a pleomorphic syndrome that resembles autoimmune and other immunologic disorders, leading to profound immune dysregulation and organ dysfunction. The most common targets of GVHD are skin, gastrointestinal tract and liver. GVHD is classified as acute graft versus host disease (aGvHD) if it occurs within the first 100 days after HSCT and chronic graft versus host disease(cGVHD) if it occurs after day 100. The skin is most frequently and earliest affected by aGvHD, followed by the gastrointestinal tract and liver. An ideal biomarker would predict the onset and severity of clinical acute GVHD and help to direct management, and this is an area of active research regarding the use of biomarkers for diagnosis and prognosis of acute GVHD. Recently, elafin has been identified as a potential plasma biomarker for aGVHD. METHOD We searched the databases PubMed, Cochrane library, and medRxiv for all studies investigating the Diagnostic or prognostic role of elafin in GVHD. We set the search strategy incorporating the search terms, 'elafin', 'graft versus host', and 'GVHD', and operated using the Boolean operators 'AND', and 'OR'. Thus, retrieved articles were then exported on an Excel® sheet, and duplicates were removed. The systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After selecting the study based on inclusion criteria, data on study characteristics and biomarker description was extracted on a pre-determined data extraction table on the Microsoft Excel version. The quality assessment of the included studies was determined using the QUIPS tool. RESULT The search revealed 547 studies and 6 studies that met the eligibility criteria of this review have been included. The major finding of our study is the significant elevation of elafin in skin aGVHD. CONCLUSION Elafin is a significant biomarker for diagnosis and prognosis of skin aGVHD and should be assessed within 2 weeks of the onset of the disease.
Collapse
Affiliation(s)
| | - Sangam Shah
- Institute of Medicine, Tribhuvan University, Maharajgunj, Nepal
| | - Rukesh Yadav
- Institute of Medicine, Tribhuvan University, Maharajgunj, Nepal
| | - Garima Dhakal
- Institute of Medicine, Tribhuvan University, Maharajgunj, Nepal
| | - Raksha Neupane
- Institute of Medicine, Tribhuvan University, Maharajgunj, Nepal
| | - Sunil Paudel
- Institute of Medicine, Tribhuvan University, Maharajgunj, Nepal
| | - Pragya Bhandari
- Institute of Medicine, Tribhuvan University, Maharajgunj, Nepal
| | | | - Ranjit Sah
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Sanjit Sah
- Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, India
- SR Sanjeevani Hospital, Siraha, Nepal
| | | |
Collapse
|
2
|
Bajonaid A, Guntaka PK, Harper M, Cutler C, Duncan C, Villa A, Sroussi HY, Woo SB, Treister NS. Characterization of orofacial features in sclerodermatous chronic graft-versus-host disease. Oral Dis 2024. [PMID: 38514965 DOI: 10.1111/odi.14932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Chronic graft-versus-host disease (cGVHD) is a leading cause of morbidity and mortality following allogeneic hematopoietic cell transplantation (alloHCT). The sclerodermatous form of cGVHD can be particularly debilitating; however, orofacial sclerodermatous involvement remains poorly described. OBJECTIVE To characterize orofacial features of sclerodermatous cGVHD in a single center cohort of patients who underwent alloHCT. STUDY DESIGN Retrospective data were collected from electronic medical records and analyzed descriptively. RESULTS There were 39 patients who received alloHCT between 1993 and 2017 and developed orofacial sclerodermatous cGVHD. Concomitant cutaneous sclerodermatous cGVHD was common (n = 20, 51%). Orofacial sclerodermatous cGVHD features included fibrous bands of the buccal mucosa (n = 23, 59%), limited mouth opening (n = 19, 54%), perioral fibrosis (n = 8, 21%), and focal gingival recession (n = 4, 10%). Oral mucosal fibrosis was observed at the site of active or resolved chronic lichenoid inflammation in 30 patients, with all but two also presenting with a history of ulcerations. Management included jaw stretching exercises (n = 10; 6 stable/improved), surgery (n = 3; 2 improved), and intralesional corticosteroid injections (n = 2; 2 improved). CONCLUSIONS Orofacial involvement with sclerodermatous cGVHD can present with multiple manifestations including fibrous banding, limited mouth opening, perioral fibrosis, and focal gingival recession. Surgical and non-surgical management strategies may improve clinical function and reduce morbidity.
Collapse
Affiliation(s)
- Amal Bajonaid
- College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | | | - Matthew Harper
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Dentistry, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Corey Cutler
- Division of Stem Cell Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christine Duncan
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, California, USA
- Herbert Wertheim College of Medicine and Miami Cancer Institute, Miami, Florida, USA
| | - Hervé Y Sroussi
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sook-Bin Woo
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nathaniel S Treister
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Mattos da Silva PQ, Ballardin BS, Torres-Pereira CC. Cancer in buccal mucosa in patients with Fanconi anemia: Report of six cases. SPECIAL CARE IN DENTISTRY 2024; 44:472-477. [PMID: 37400941 DOI: 10.1111/scd.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Fanconi anemia (FA) is a recessive hereditary disease characterized by bone marrow failure, and the treatment is hematopoietic stem cell transplantation (HSCT). Patients diagnosed with FA are more predisposed to develop oral squamous cell carcinoma (SCC), and this risk increases in transplant patients. The clinical characteristics of the oral manifestations of SCC in this group of patients do not differ from the lesions present in patients without the disease; however, they can be diagnosed in young patients and less common locations, such as, for example, in the buccal mucosa. OBJECTIVE To report a case series of patients diagnosed with FA with oral SCC. METHOD Included in this case series are six patients diagnosed with SCC in the buccal mucosa with similar clinical characteristics. FINAL CONSIDERATIONS There are still difficulties in establishing the natural history of oral lesions in patients with FA. Thus, disclosing a series of cases with similar changes may be relevant to improving and refining the multidisciplinary team's clinical view of suspected SCC or oral potentially malignant disorders (OPMD), providing surveillance and timely management.
Collapse
Affiliation(s)
- Priscila Queiroz Mattos da Silva
- Multiprofessional Residency Program in Oncology and Hematology, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Bárbara Soldatelli Ballardin
- Multiprofessional Residency Program in Oncology and Hematology, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
- Post Graduate Program in Dentistry, Department of Stomatology, Universidade Federal do Paraná, Curitiba, Brazil
| | - Cassius Carvalho Torres-Pereira
- Multiprofessional Residency Program in Oncology and Hematology, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
- Post Graduate Program in Dentistry, Department of Stomatology, Universidade Federal do Paraná, Curitiba, Brazil
| |
Collapse
|
4
|
Graft-Versus-Host Disease Associated Post-operative Complications After Pelvic Reconstructive Surgery: A Case Report. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-11594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Graft-versus-host disease (GVHD) can occur after allogeneic bone marrow transplantation (BMT) and can affect the skin, gastrointestinal tract, lungs, liver, and vulvovaginal areas. Case Presentation: This case report described a 65-year-old multiparous patient with myelodysplastic syndrome who underwent a matched unrelated donor transplant approximately 3 years before her surgery. After her BMT she developed GVHD. She underwent anterior and posterior repair and uterosacral ligament suspension for stage III post-hysterectomy vaginal vault prolapse. Her postoperative course was complicated by mental status changes, abnormal liver function tests, and increasing abdominal distention. All her post-operative symptoms were resolved with conservative management. Conclusions: This case presentation highlights the potential atypical post-operative course of BMT patients with GVHD. The management of patients with GVHD relies heavily on the early involvement of hematologists.
Collapse
|
5
|
Construction of HGF-Displaying Yeast by Cell Surface Engineering. Microorganisms 2022; 10:microorganisms10071373. [PMID: 35889092 PMCID: PMC9316346 DOI: 10.3390/microorganisms10071373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatocyte growth factor (HGF) has been investigated as a regulator for immune reactions caused by transplantation and autoimmune diseases and other biological functions. Previous studies demonstrated that cDNA-encoding HGF administration could inhibit acute graft-versus-host disease (GVHD) after treatment via hematopoietic stem cell transplantation. This study aimed to show the preparation of HGF protein on yeast cell surfaces to develop a tool for the oral administration of HGF to a GVHD mouse model. In this study, full-length HGF and the heavy chain of HGF were genetically fused with α-agglutinin and were successfully displayed on the yeast cell surface. This study suggested that yeast cell surface display engineering could provide a novel administration route for HGF.
Collapse
|
6
|
Dean D, Sroussi H. Oral Chronic Graft-Versus-Host Disease. FRONTIERS IN ORAL HEALTH 2022; 3:903154. [PMID: 35719318 PMCID: PMC9205403 DOI: 10.3389/froh.2022.903154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
Chronic oral graft-versus-host disease (cGVHD) is a complex, frequent, and highly impactful complication of allogeneic hematopoietic cell transplantation (alloHCT). It represents the leading cause of morbidity and mortality in long-term alloHCT survivors. cGVHD can affect almost any visceral organ system and commonly affects the skin, eyes and mouth, manifesting with signs and symptoms similar to other known immune-mediated and autoimmune diseases. Oral manifestations of GVHD include inflammation, thinning, and ulceration of oral mucosal tissues (similar to lichen planus), lymphocyte-mediated salivary gland dysfunction (similar to Sjögren/Sicca Syndrome), and decreased oral opening (trismus) secondary to sclerosis of oral and perioral tissues (analogous to limitation in scleroderma). Potential sequelae include severe mucosal pain, compromised nutrition, weight loss, limitation in opening, and sometimes irreversible fibrosis of the salivary glands. While some cases can be managed with topical therapies, management may also require long-term targeted immunosuppressive and/or corticosteroid therapy with associated risk of local and systemic infection, hyperglycemia, kidney dysfunction, osteopenia/osteoporosis, and possibly secondary malignancies. The aim of this mini-review is to provide an up-to-date review of literature related to the diagnosis and management of oral cGVHD to aid dental and medical clinicians in optimizing oral cGVHD therapy while minimizing potential adverse effects.
Collapse
Affiliation(s)
- David Dean
- Department of Oral Medicine, University of Washington/Seattle Cancer Care Alliance, Seattle, WA, United States
- *Correspondence: David Dean
| | - Herve Sroussi
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital and Dana Farber Cancer Institute Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, United States
| |
Collapse
|
7
|
Shetty SS, Maruthi M, Dhara V, de Arruda JAA, Abreu LG, Mesquita RA, Teixeira AL, Silva TA, Merchant Y. Oral mucositis: Current knowledge and future directions. Dis Mon 2021; 68:101300. [PMID: 34758917 DOI: 10.1016/j.disamonth.2021.101300] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Oral mucositis secondary to head and neck chemoradiation displays a complex molecular pathogenesis involving epithelial and microvascular injury, release of pro-inflammatory cytokines, and host-microbiome communications. These processes lead to oxidative stress and the release of reactive oxygen species that stifle the structural integrity of the oral mucosa, with emergence of erosions and ulcers. The consequences are malnutrition, psychological/psychiatric symptoms, poor quality of life, and occurrence of opportunistic infections. The latter pose a major challenge due to the risk of interruption of anti-neoplastic therapy, tumour recurrence and, ultimately, death. This article aims to present the clinical characteristics, molecular pathogenesis, and an overview of the predisposing factors and current management of oral mucositis. It is anticipated that the future direction of the management of oral mucositis will focus on evidence-based prehabilitation and pre- and per-chemoradiation therapy monitoring.
Collapse
Affiliation(s)
- Sameep S Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, A Constituent of MAHE, Manipal 576104, India.
| | - Meghana Maruthi
- Department of Dental Rehabilitative Oncology, HealthCare Global Enterprises Ltd., Bangalore, India.
| | - Vasantha Dhara
- Consultant Maxillofacial Surgeon, Hyderabad, Telangana, India.
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3202 D, CEP: 31.270-910, Belo Horizonte, Minas Gerais, Brazil.
| | - Lucas Guimarães Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Ricardo Alves Mesquita
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Antonio Lucio Teixeira
- Faculdade Santa Casa BH, Belo Horizonte, Brazil. Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
| | - Tarcília Aparecida Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3204, CEP: 31.270-910, Belo Horizonte, Minas Gerais, Brazil.
| | - Yash Merchant
- Consultant Maxilofacial Surgeon, Pune, Maharashtra, India.
| |
Collapse
|
8
|
Fall-Dickson JM, Pavletic SZ, Mays JW, Schubert MM. Oral Complications of Chronic Graft-Versus-Host Disease. J Natl Cancer Inst Monogr 2020; 2019:5551350. [PMID: 31425593 DOI: 10.1093/jncimonographs/lgz007] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/15/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023] Open
Abstract
The increasing clinical indications for hematopoietic stem cell transplantation (HSCT) and improved clinical care throughout and following HSCT have led to not only long-term survival but also to an increasing incidence and prevalence of graft-versus-host disease (GVHD). Chronic GVHD (cGVHD) affects almost 50% of adult patients post-HSCT, with increasing incidence in pediatric patients as well. Oral cGVHD specifically has a reported prevalence ranging from 45% to 83% in patients who develop cGVHD and is more extensive in adult patients than in children. Oral cGVHD affects patients through clinically significant oral symptoms that may lead to significantly decreased caloric intake, oral infections, and increased health service utilization, and may thus affect overall health and survival. The most commonly used therapy for mucosal involvement of oral cGVHD is topical high-dose and ultra-high potency corticosteroids, and calcineurin inhibitors. This review of oral complications of cGVHD presents the clinical significance of oral cGVHD to HSCT survivors, our current understanding of the pathobiology of oral cGVHD and gaps in this evidence, and the global targeted interdisciplinary clinical research efforts, including the National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease. Current challenges regarding the management of oral cGVHD and strategies to advance our scientific understanding of this clinically significant chronic oral disease are presented.
Collapse
Affiliation(s)
- Jane M Fall-Dickson
- Department of Professional Nursing Practice, Georgetown University School of Nursing & Health Studies, Washington, DC
| | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Division of Intramural Research, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Jacqueline W Mays
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Division of Intramural Research, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Mark M Schubert
- Department of Oral Medicine, University of Washington, School of Dentistry and Seattle Cancer Care Alliance and Oral Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|
9
|
Giaccone L, Felicetti F, Butera S, Faraci D, Cerrano M, Dionisi Vici M, Brunello L, Fortunati N, Brignardello E, Bruno B. Optimal Delivery of Follow-Up Care After Allogeneic Hematopoietic Stem-Cell Transplant: Improving Patient Outcomes with a Multidisciplinary Approach. J Blood Med 2020; 11:141-162. [PMID: 32523389 PMCID: PMC7237112 DOI: 10.2147/jbm.s206027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/02/2020] [Indexed: 01/05/2023] Open
Abstract
The increasing indications for allogeneic stem-cell transplant in patients with hematologic malignancies and non-malignant diseases combined with improved clinical outcomes have contributed to increase the number of long-term survivors. However, survivors are at increased risk of developing a unique set of complications and late effects, besides graft-versus-host disease and disease relapse. In this setting, the management capacity of a single health-care provider can easily be overwhelmed. Thus, to provide appropriate survivorship care, a multidisciplinary approach for the long-term follow-up is essential. This review aims at summarizing the most relevant information that a health-care provider should know to establish a follow-up care plan, in the light of individual exposures and risk factors, that includes all organ systems and considers the psychological burden of these patients.
Collapse
Affiliation(s)
- Luisa Giaccone
- Division of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, University of Torino, Torino, Italy
| | - Francesco Felicetti
- Transition Unit for Childhood Cancer Survivors, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Sara Butera
- Division of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, University of Torino, Torino, Italy
| | - Danilo Faraci
- Division of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, University of Torino, Torino, Italy
| | - Marco Cerrano
- Division of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, University of Torino, Torino, Italy
| | - Margherita Dionisi Vici
- Transition Unit for Childhood Cancer Survivors, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Lucia Brunello
- Division of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, University of Torino, Torino, Italy
| | - Nicoletta Fortunati
- Transition Unit for Childhood Cancer Survivors, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Enrico Brignardello
- Transition Unit for Childhood Cancer Survivors, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Benedetto Bruno
- Division of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, University of Torino, Torino, Italy
| |
Collapse
|
10
|
Stolze J, Vlaanderen KCE, Raber-Durlacher JE, Brand HS. The impact of hematological malignancies and their treatment on oral health-related quality of life as assessed by the OHIP-14: a systematic review. Odontology 2020; 108:511-520. [PMID: 31955297 DOI: 10.1007/s10266-019-00479-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022]
Abstract
Patients with hematologic cancers often develop acute and chronic oral complications from their disease and its treatment. These problems could change patients' oral health-related quality of life (OHRQoL) negatively. Quality of life (QoL) has become an increasingly important outcome measure in oncology. This systematic literature review evaluates the impact of hematological malignancies and their treatment on OHRQoL as assessed by the Oral Health Impact Profile (OHIP-14) questionnaire. Medline through Pubmed and Web of Science were searched through April 2017. Two randomized controlled trials, one cohort study, one cross-sectional study, and one case-control study were included. Heterogeneity across the included studies did not allow for meta-analysis. OHIP-14 domains that were frequently given the highest scores were functional limitation (67%), physical pain (50%), physical disability (50%), and psychological discomfort (33%). The domains that were frequently given the lowest scores were social handicap (100%), social disability (100%), and psychological disability (67%). Insufficient evidence is available to draw any robust conclusions regarding OHRQoL assessed by the OHIP-14 in individuals with hematological malignancies. However, functional limitations because of problems with oral mucosal tissues, the dentition, or dentures, seem to have a larger negative impact on the OHRQoL than social aspects associated with oral health problems. Well-designed larger studies are required to determine effects of hematological malignancies as well as acute and long-term effects of their treatment on patients' OHRQoL.
Collapse
Affiliation(s)
- Juliette Stolze
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands.,Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands
| | - Kim C E Vlaanderen
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands.,Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands
| | - Judith E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands.,Department of Oral Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands. .,Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), room 12N-37, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
| |
Collapse
|
11
|
Carrozzo M, Porter S, Mercadante V, Fedele S. Oral lichen planus: A disease or a spectrum of tissue reactions? Types, causes, diagnostic algorhythms, prognosis, management strategies. Periodontol 2000 2019; 80:105-125. [PMID: 31090143 DOI: 10.1111/prd.12260] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oral lichen planus and lichenoid lesions comprise a group of disorders of the oral mucosa that likely represent a common reaction pattern to 1 or more unknown antigens. The coexistence of hyperkeratotic striation/reticulation, varying degrees of mucosal inflammation from mild erythema to severe widespread ulceration, and a band-like infiltrate of mononuclear inflammatory cells including activated T lymphocytes, macrophages, and dendritic cells, are considered suggestive of oral lichen planus and lichenoid lesions. Several classification systems of oral lichen planus and lichenoid lesions have been attempted, although none seem to be comprehensive. In this paper, we present a classification of oral lichen planus and lichenoid lesions that includes oral lichen planus, oral lichenoid contact lesions, oral lichenoid drug reactions, oral lichenoid lesions of graft vs. host disease, discoid lupus erythematosus, and systemic lupus erythematosus, lichen planus-like variant of paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome, chronic ulcerative stomatitis, lichen planus pemphigoides, solitary fixed drug eruptions, and lichen sclerosus. We present the clinical and diagnostic aspects of oral lichen planus and lichenoid lesions, and discuss related treatment options.
Collapse
Affiliation(s)
- Marco Carrozzo
- Centre for Oral Health Research, Oral Medicine Department, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Porter
- UCL Eastman Dental Institute, University College London, London, UK
| | | | - Stefano Fedele
- UCL Eastman Dental Institute, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, London, UK
| |
Collapse
|
12
|
Adams TG, Sumner LE, Casagrande R. Estimating Risk of Hematopoietic Acute Radiation Syndrome in Children. HEALTH PHYSICS 2017; 113:452-457. [PMID: 28968347 DOI: 10.1097/hp.0000000000000720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Following a radiological terrorist attack or radiation accident, the general public may be exposed to radiation. Historically, modeling efforts have focused on radiation effects on a "reference man"-a 70-kg, 180-cm-tall, 20- to 30-y-old male-which does not adequately reflect radiation hazard to special populations, particularly children. This work examines the radiosensitivity of children with respect to reference man to develop a set of parameters for modeling hematopoetic acute radiation syndrome in children. This analysis was performed using animal studies and the results verified using data from medical studies. Overall, the hematopoietic system in children is much more radiosensitive than that in adults, with the LD50 for children being 56% to 91% of the LD50 of adults, depending on age.
Collapse
Affiliation(s)
- Tim G Adams
- *Gryphon Scientific LLC., Takoma Park, MD 20912
| | | | | |
Collapse
|
13
|
Seno K, Yasunaga M, Kajiya H, Izaki-Hagio K, Morita H, Yoneda M, Hirofuji T, Ohno J. Dynamics of M1 macrophages in oral mucosal lesions during the development of acute graft-versus-host disease in rats. Clin Exp Immunol 2017; 190:315-327. [PMID: 28862740 DOI: 10.1111/cei.13043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2017] [Indexed: 12/15/2022] Open
Abstract
The role of macrophage infiltrates in oral mucosal acute graft-versus-host disease (AGVHD) remains unclear, although clinical studies suggest that macrophage infiltration correlates directly with the severity of AGVHD. In this study, we investigated the role of M1 macrophage infiltration in the oral mucosa of rats with AGVHD. Lewis rat spleen cells were injected into (Lewis × Brown Norway) F1 rats to induce systemic GVHD. Tongue samples were evaluated using histology, immunohistochemistry, dual immunofluorescence, real-time reverse transcription-polymerase chain reaction, Transwell migration assays and Stamper-Woodruff binding assays. At the onset of oral mucosal AGVHD, dual immunofluorescence and migration assays revealed that M1 macrophages had accumulated in the basement membrane (BM) region via the laminin/CD29 β1 integrin pathway. Macrophage-secreted matrix metalloproteinase-2 was related to BM degradation. The adhesion of macrophages to the oral epithelium could be inhibited by pretreating macrophages with a CC chemokine receptor 2 (CCR2) antibody and/or pretreating lesion sections with monocyte chemoattractant protein-1 (MCP-1) antibody. Our data show that the migration and adhesion of M1 macrophages are associated with oral mucosal AGVHD, which is mediated in part by both laminin/CD29 β 1 intern and MCP-1/CCR2 pathways. Therefore, our study provides additional support for the contribution of macrophage infiltrate to the development of oral mucosal AGVHD.
Collapse
Affiliation(s)
- K Seno
- Section of General Dentistry, Department of General Dentistry, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan
| | - M Yasunaga
- Section of Orthodontics, Department of Oral Growth and Development, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan.,Research Center for Regenerative Medicine, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan
| | - H Kajiya
- Research Center for Regenerative Medicine, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan.,Section of Cellular Physiology, Department of Physiological Science and Molecular Biology, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan
| | - K Izaki-Hagio
- Section of General Dentistry, Department of General Dentistry, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan.,Research Center for Regenerative Medicine, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan
| | - H Morita
- Section of General Dentistry, Department of General Dentistry, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan
| | - M Yoneda
- Section of General Dentistry, Department of General Dentistry, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan
| | - T Hirofuji
- Section of General Dentistry, Department of General Dentistry, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan
| | - J Ohno
- Research Center for Regenerative Medicine, Fukuoka Dental College, Sawara-ku, Fukuoka, Japan
| |
Collapse
|
14
|
Atilla E, Atilla PA, Toprak SK, Demirer T. A review of late complications of allogeneic hematopoietic stem cell transplantations. Clin Transplant 2017; 31. [PMID: 28753218 DOI: 10.1111/ctr.13062] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 12/13/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective and curative treatment of different malignant and non-malignant diseases. Early transplant-related mortality after allo-HSCT has decreased with reduced-intensity conditioning regimens and effective anti-infectious treatments, but late transplant-related mortality is still a problem. Physicians are now paying more attention to late complications that may worsen the quality of life of many transplant recipients. Chronic graft versus host disease (cGVHD) is one of the major causes of late transplant-related mortality after allo-HSCT. This review discusses recent advances that have been made in clinical evaluation and treatment of late transplant-related complications including cGVHD. The different sites of involvement are organs, especially the skin and eye, and the gastrointestinal, endocrinologic, metabolic, renal, cardiologic, pulmonary, connective tissue, and neurological systems. In addition, this review includes infections and secondary malignancies in post-transplant settings that worsen quality of life in long-term follow-ups.
Collapse
Affiliation(s)
- Erden Atilla
- Department of Hematology, Ankara University Medical School, Ankara, Turkey
| | - Pinar Ataca Atilla
- Department of Hematology, Ankara University Medical School, Ankara, Turkey
| | | | - Taner Demirer
- Department of Hematology, Ankara University Medical School, Ankara, Turkey
| |
Collapse
|
15
|
Yuan A, Chai X, Martins F, Arai S, Arora M, Correa ME, Pidala J, Cutler CS, Lee SJ, Treister NS. Oral chronic GVHD outcomes and resource utilization: a subanalysis from the chronic GVHD consortium. Oral Dis 2015; 22:235-40. [PMID: 26708609 DOI: 10.1111/odi.12429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/25/2015] [Accepted: 12/16/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study evaluated the extent to which oral chronic graft-versus-host disease (cGVHD) consensus assessments are predictive of management across institutions with and without oral medicine (OM) centers, and whether ancillary care guidelines are followed within clinical practice. METHODS Longitudinal oral cGVHD data were abstracted from the cGVHD Consortium, and additional mouth-specific management data were analyzed across five transplant centers. RESULTS Seventy-nine patients with 656 visits were observed for a median of 7.1 months with one visit per follow-up month. Ancillary therapies for oral cGVHD were prescribed for 67% of patients for a median of 0.46 months (per follow-up month) at OM centers and 0.78 months at non-OM centers. Patients treated with ancillary therapy were more likely to have an National Institutes of Health (NIH) mouth score of ≥1 (P < 0.001, odds ratio: 5.1) and mouth pain (P = 0.01, odds ratio: 2.6). The odds ratios of receiving ancillary therapy from OM experts were higher than transplant physicians (53%; P = 0.03). CONCLUSIONS Oral cGVHD consensus assessments corresponding with ancillary therapy use were mouth pain and NIH mouth score, with higher odds ratios of receiving therapy from OM experts. Ancillary care guidelines for oral cGVHD are reflected in academic clinical practice with respect to utilization of recommended prescriptions.
Collapse
Affiliation(s)
- A Yuan
- Division of Oral Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - X Chai
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - F Martins
- Department of Oral Pathology and Oral Diagnosis, University of São Paulo School of Dentistry, São Paulo, Brazil
| | - S Arai
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA, USA
| | - M Arora
- Department of Medicine, University of Minnesota, Boston, MA, USA
| | - M E Correa
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Oral Medicine Ambulatory, Bone Marrow Transplantation Unit, Hematology and Blood Transfusion Center, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - J Pidala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - C S Cutler
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - S J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - N S Treister
- Division of Oral Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| |
Collapse
|
16
|
DePalo J, Chai X, Lee SJ, Cutler CS, Treister N. Assessing the relationship between oral chronic graft-versus-host disease and global measures of quality of life. Oral Oncol 2015; 51:944-9. [PMID: 26277616 DOI: 10.1016/j.oraloncology.2015.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/26/2015] [Accepted: 07/30/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Chronic GVHD (cGVHD) is a frequent complication of allogeneic hematopoietic stem cell transplantation (HSCT) and affects multiple organ systems, with the oral cavity being one of the most frequently affected sites. Patients with cGVHD experience reduced quality of life (QOL), yet the specific impact of oral cGVHD on QOL is poorly understood. The objective of this study was to characterize the impact of oral cGVHD on global measures of QOL. MATERIALS AND METHODS QOL data were collected using the FACT-BMT and SF-36 instruments for 569 patients enrolled in the Chronic GVHD Consortium, with a total of 1915 follow-up visits. At study enrollment, patients were categorized as isolated oral cGVHD (n=22), oral and concomitant extra-oral cGVHD (n=420), and only extra-oral cGVHD (n=127). Utilizing all longitudinal data, QOL scores were compared using a multivariable linear model controlling for demographic, transplant, and cGVHD characteristics. RESULTS Patients with isolated oral cGVHD reported better physical well-being (P=0.009), BMT well-being (P=0.01), and decreased bodily pain (P=0.01) compared to patients with oral and concomitant extra-oral cGVHD, but the differences in scores did not reach the defined threshold for clinical significance (6 points for FACT-BMT domains and 5 points for SF-36 domains). CONCLUSIONS Global QOL scores are similar in patients with isolated oral cGVHD and patients with oral and concomitant extra-oral cGVHD.
Collapse
Affiliation(s)
- Joseph DePalo
- Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Xiaoyu Chai
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109, USA
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109, USA
| | - Corey S Cutler
- Hematologic Malignancies, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Nathaniel Treister
- Brigham and Women's Hospital, Division of Oral Medicine and Dentistry, 1620 Tremont Street, Suite BC-3-028, Boston, MA 02120, USA.
| |
Collapse
|
17
|
Hull K, Kerridge I, Avery S, McCullough M, Ritchie D, Szer J. Oral chronic graft-versus-host disease in Australia: clinical features and challenges in management. Intern Med J 2015; 45:702-10. [DOI: 10.1111/imj.12812] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/21/2015] [Indexed: 02/06/2023]
Affiliation(s)
- K. Hull
- Department of Clinical Haematology and BMT Service; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - I. Kerridge
- Haematology Department; Royal North Shore Hospital; Sydney New South Wales Australia
- Northern Blood Research Centre, Kolling Institute, Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - S. Avery
- Malignant Haematology and Stem Cell Transplantation Service; Alfred Hospital; Melbourne Victoria Australia
| | - M. McCullough
- Faculty of Medicine, Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - D. Ritchie
- Department of Clinical Haematology and BMT Service; Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - J. Szer
- Department of Clinical Haematology and BMT Service; Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| |
Collapse
|
18
|
Grossmann SDMC, Oliveira CDNAD, Souto GR, Góes C, Mesquita RA. Oral lichenoid lesion: A review of the literature. World J Stomatol 2015; 4:103-107. [DOI: 10.5321/wjs.v4.i2.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/26/2015] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
The oral lichenoid lesion (OLL) is response that occurs on the oral mucosa. The OLL include allergic response to the dental materials, drugs, and on graft-vs-host disease (GVHD). OLL to dental material happen when restorative materials, most commonly amalgam, are in direct contact with the mucosa in sensitized individuals. Medications that produce OLL are oral hypoglycemic agents, angiotensin-converting enzyme inhibitors, and nonsteroidal anti-inflammatory agents. GVHD is a complication in bone marrow transplantation and OLL is a common lesion observed in this disease especially in chronic GVHD. The clinical and histological aspects of OLL are similar to oral lichen planus and turn it difficult to make a differential diagnosis. The purpose of this paper is review about OLL related to the dental materials, drug use and GVHD.
Collapse
|
19
|
Carpenter PA, Kitko CL, Elad S, Flowers MED, Gea-Banacloche JC, Halter JP, Hoodin F, Johnston L, Lawitschka A, McDonald GB, Opipari AW, Savani BN, Schultz KR, Smith SR, Syrjala KL, Treister N, Vogelsang GB, Williams KM, Pavletic SZ, Martin PJ, Lee SJ, Couriel DR. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report. Biol Blood Marrow Transplant 2015; 21:1167-87. [PMID: 25838185 DOI: 10.1016/j.bbmt.2015.03.024] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/27/2015] [Indexed: 12/26/2022]
Abstract
The 2006 National Institutes of Health (NIH) Consensus paper presented recommendations by the Ancillary Therapy and Supportive Care Working Group to support clinical research trials in chronic graft-versus-host disease (GVHD). Topics covered in that inaugural effort included the prevention and management of infections and common complications of chronic GVHD, as well as recommendations for patient education and appropriate follow-up. Given the new literature that has emerged during the past 8 years, we made further organ-specific refinements to these guidelines. Minimum frequencies are suggested for monitoring key parameters relevant to chronic GVHD during systemic immunosuppressive therapy and, thereafter, referral to existing late effects consensus guidelines is advised. Using the framework of the prior consensus, the 2014 NIH recommendations are organized by organ or other relevant systems and graded according to the strength and quality of supporting evidence.
Collapse
Affiliation(s)
- Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Carrie L Kitko
- Blood and Marrow Transplantation Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Juan C Gea-Banacloche
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jörg P Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Flora Hoodin
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan
| | - Laura Johnston
- Department of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Anita Lawitschka
- St. Anna Children's Hospital, Medical University, Vienna, Austria
| | - George B McDonald
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anthony W Opipari
- Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, Michigan
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kirk R Schultz
- Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital and University of BC, Vancouver, British Columbia
| | - Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Georgia B Vogelsang
- Oncology Department, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kirsten M Williams
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Steven Z Pavletic
- Center for Cancer Research National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel R Couriel
- Blood and Marrow Transplantation Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| |
Collapse
|
20
|
Bassim CW, Fassil H, Mays JW, Edwards D, Baird K, Steinberg SM, Cowen EW, Naik H, Datiles M, Stratton P, Gress RE, Pavletic SZ. Oral disease profiles in chronic graft versus host disease. J Dent Res 2015; 94:547-54. [PMID: 25740857 DOI: 10.1177/0022034515570942] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
At least half of patients with chronic graft-versus-host-disease (cGVHD), the leading cause of morbidity and non-relapse mortality after allogeneic stem cell transplantation, have oral manifestations: mucosal lesions, salivary dysfunction, and limited mouth-opening. cGVHD may manifest in a single organ or affect multiple organ systems, including the mouth, eyes, and the skin. The interrelationship of the 3 oral manifestations of cGVHD with each other and with the specific manifestations of extraoral cGVHD has not been studied. In this analysis, we explored, in a large group of patients with cGVHD, the potential associations between: (1) oral mucosal disease and erythematous skin disease, (2) salivary gland dysfunction and lacrimal gland dysfunction, and (3) limited mouth-opening and sclerotic skin cGVHD. Study participants, enrolled in a cGVHD Natural History Protocol (NCT00331968, n = 212), underwent an oral examination evaluating: (1) mucosal cGVHD [NIH Oral Mucosal Score (OMS)], (2) salivary dysfunction (saliva flow and xerostomia), and (3) maximum mouth-opening measurement. Parameters for dysfunction (OMS > 2, saliva flow ≤ 1 mL/5 min, mouth-opening ≤ 35 mm) were analyzed for association with skin cGVHD involvement (erythema and sclerosis, skin symptoms), lacrimal dysfunction (Schirmer's tear test, xerophthalmia), Lee cGVHD Symptom Scores, and NIH organ scores. Oral mucosal disease (31% prevalence) was associated with skin erythema (P < 0.001); salivary dysfunction (11% prevalence) was associated with lacrimal dysfunction (P = 0.010) and xerostomia with xerophthalmia (r = 0.32, P = 0.001); and limited mouth-opening (17% prevalence) was associated with skin sclerosis (P = 0.008) and skin symptoms (P = 0.001). There was no association found among these 3 oral cGVHD manifestations. This analysis supports the understanding of oral cGVHD as 3 distinct diseases: mucosal lesions, salivary gland dysfunction, and mouth sclerosis. Clear classification of oral cGVHD as 3 separate manifestations will improve clinical diagnosis, observational research data collection, and the definitions of outcome measures in clinical trials.
Collapse
Affiliation(s)
- C W Bassim
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD, USA
| | - H Fassil
- Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA Tufts University School of Dental Medicine, Boston, MA, USA
| | - J W Mays
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD, USA
| | - D Edwards
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD, USA
| | - K Baird
- Pediatric Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - S M Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - E W Cowen
- Dermatology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - H Naik
- Dermatology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - M Datiles
- National Eye Institute, NIH, Bethesda, MD, USA
| | - P Stratton
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - R E Gress
- Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - S Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| |
Collapse
|
21
|
Kung AYH, Zhang S, Zheng LW, Wong GHM, Chu CH. Oral health status of chinese paediatric and adolescent oncology patients with chemotherapy in Hong Kong: a pilot study. Open Dent J 2015; 9:21-30. [PMID: 25674168 PMCID: PMC4319200 DOI: 10.2174/1874210601509010021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/08/2014] [Accepted: 12/14/2014] [Indexed: 11/23/2022] Open
Abstract
Aim: To study the oral health status of Chinese children and adolescents undergoing chemotherapy in Hong Kong. Method: All Chinese children and adolescent oncology patients aged 18 or below attending the Children's Centre for Cancer and Blood Disease at a hospital for chemotherapy were invited and parental consent was sought before they were accepted into the study. The study comprised of 1) a parental questionnaire, 2) the collection of medical history and 3) a clinical examination for tooth decay (caries) and mucosal status. Results: A total of 69 patients were invited, and they all participated in this study. Their mean age was 9.2±5.0 and 44 (64%) were males. Twenty-six patients (38%) had no caries experience (DMFT and/or dmft = 0). Higher caries experience was detected in participants that were not born in Hong Kong, had completed active chemotherapy, participated in school dental care service and whose parents had low educational levels. There were 41 patients with active chemotherapy, 24 of whom were diagnosed with acute leukaemia, 5 with haematological malignancies other than leukaemia and 11 with solid tumours. Antimetabolites, cytotoxic antibiotics, alkylating agents and plant alkaloids were administered in 49%, 32%, 24% and 22% of them, respectively. Twenty-six (63%) patients showed no mucosal complications. The most common oral complication was oral mucositis (24%) followed by petechiae (10%). Conclusion: About two-thirds of paediatric and adolescent cancer patients had caries experience, which was more common among those who had completed chemotherapy. Oral mucositis followed by petechiae were the two most common complications of receiving chemotherapy.
Collapse
Affiliation(s)
- A Y H Kung
- Faculty of Dentistry, the University of Hong Kong, Republic of China
| | - S Zhang
- Faculty of Dentistry, the University of Hong Kong, Republic of China
| | - L W Zheng
- Faculty of Dentistry, the University of Hong Kong, Republic of China
| | - G H M Wong
- Faculty of Dentistry, the University of Hong Kong, Republic of China
| | - C H Chu
- Faculty of Dentistry, the University of Hong Kong, Republic of China
| |
Collapse
|
22
|
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is used for the treatment of a variety of disorders, primarily hematologic malignancies. Graft-versus-host disease (GVHD) is a significant complication following allo-HCT and a major cause of morbidity and mortality. The oral cavity is frequently involved in GVHD, leading to pain, functional impairment, and reduced quality of life. Early diagnosis, management, and long-term follow-up of oral GVHD are important components of overall patient care.
Collapse
Affiliation(s)
- Michal Kuten-Shorrer
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Sook-Bin Woo
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 1620 Tremont Street, 3rd Floor, Boston, MA 02115, USA
| | - Nathaniel S Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 1620 Tremont Street, 3rd Floor, Boston, MA 02115, USA.
| |
Collapse
|
23
|
Oral manifestations compatible with chronic graft-versus-host disease in patients with Fanconi anemia. Biol Blood Marrow Transplant 2014; 21:275-80. [PMID: 25316110 DOI: 10.1016/j.bbmt.2014.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/07/2014] [Indexed: 01/19/2023]
Abstract
Fanconi anemia (FA) is a genetic disease that is characterized by several congenital abnormalities and progressive bone marrow failure and is associated with an increased susceptibility to malignant disorders. Currently, the only potential cure for hematological disorders is hematopoietic stem cell transplantation (HSCT). However, 1 of the most common complications after HSCT is the development of oral chronic graft-versus-host disease (cGVHD), which is also a risk factor for the development of cancer, particularly oral squamous cell carcinoma. Therefore, the purpose of this study was to describe the prevalence and characteristics of oral manifestations compatible with cGVHD in patients diagnosed with FA according to the National Institutes of Health (NIH) consensus criteria. A total of 96 patients (51 females, 45 males; median age, 16 years) with FA, who were in medical follow-up after HSCT at the outpatient clinic of the bone marrow transplantation unit (Hospital de Clínicas from the Universidade Federal do Paraná) underwent an oral evaluation between January 2013 and December 2013. Post-HSCT periods varied from 1 to 261 months and were divided into 3 periods: immediate post-HSCT period; intermediate post-HSC period, and late post-HSCT period. Among the evaluated patients, 40 of 96 (42%) presented with oral manifestations of cGVHD, with 29 of 40 (73%) of these patients in the late post-HSCT period. NIH scale scores varied from 0 to 10, and lichenoid and hyperkeratotic lesions were the abnormalities most frequently observed (100%). Overall, a high prevalence of oral manifestations was observed for cGVHD patients with FA. These data highlight the importance of monitoring oral manifestations compatible with cGVHD to identify and treat individuals with a higher risk of developing oral cancer.
Collapse
|
24
|
Characterization of oral involvement in acute graft-versus-host disease. Biol Blood Marrow Transplant 2014; 20:1717-21. [PMID: 24979731 DOI: 10.1016/j.bbmt.2014.06.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/23/2014] [Indexed: 01/08/2023]
Abstract
Acute graft-versus-host-disease (aGVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (HSCT). The purpose of this study was to characterize the oral features associated with aGVHD in patients who underwent HSCT between 1995 and 2010 and developed prominent oral aGVHD. Data was collected from patient medical records and analyzed descriptively. Twenty-one cases were identified, of which 5 (24%) demonstrated only oral features; the remaining 16 had variable involvement of skin (n = 14), liver (n = 7), and gut (n = 5). The median time to onset of any sign of aGVHD was 22 days (range, 8 to 154 days), and that for onset of oral aGVHD was 35 days (range, 11 to 159 days). Sites affected by nonspecific erythema and ulcerations included buccal mucosa (19 of 21; 90%) tongue (18 of 21; 86%; dorsum in 8), labial mucosa (16 of 21; 76%), palatal mucosa (15 of 21; 71%; hard palate in 7), and floor of mouth (7 of 21; 33%). Eight cases (38%) presented with lip ulceration and crusting. In addition to systemic therapies, topical solutions of dexamethasone, tacrolimus, and morphine were used for ancillary support. Oral features of aGVHD may be the initial manifestation and include nonspecific erythema and ulcerations of keratinized and nonkeratinized mucosa and lips. Intensive topical therapies may help reduce symptoms and promote healing.
Collapse
|
25
|
Zadik Y, Zeevi I, Luboshitz-Shon N, Dakwar N, Wolff A, Shapira MY, Or R, Elad S. Safety and efficacy of an intra-oral electrostimulator for the relief of dry mouth in patients with chronic graft versus host disease: Case series. Med Oral Patol Oral Cir Bucal 2014; 19:e212-9. [PMID: 24121920 PMCID: PMC4048107 DOI: 10.4317/medoral.19429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 09/06/2013] [Indexed: 11/11/2022] Open
Abstract
Objectives: Patients with chronic graft-versus-host disease (cGVHD) often suffer from dry mouth and oral mucosal lesions. The primary objective of this study was to investigate the safety of an intra-oral electrostimulator (GenNarino) in symptomatic cGVHD patients. The secondary objective was to study the impact on the salivary gland involvement of cGVHD patients.
Study Design: This paper presents a case series. The study included patients treated for 4 weeks, randomly assigned to the active device and then crossed-over to a sham-device or vice versa. The patients and clinicians were blind to the treatment delivered. Data regarding oral mucosal and salivary gland involvement were collected.
Results: Six patients were included in this series. Most of the intraoral areas with manifestations of cGVHD were not in contact with the GenNarino device. Two patients developed mild mucosal lesions in areas in contact with the GenNarino during the study. However, only one of them had a change in the National Institutes of Health (NIH) score for oral cGVHD. The unstimulated and stimulated salivary flow rate increased in 4 out of the 5 patients included in this analysis. Symptoms of dry mouth and general oral comfort improved.
Conclusion: This study suggests that GenNarino is safe in cGVHD patients with respect to oral tissues. Furthermore the use of GenNarino resulted in subjective and objective improvements in dry mouth symptoms. A large scale study is needed to confirm the impact and safety of GenNarino on systemic cGVHD.
Key words:Dry mouth, graft versus host disease, electrostimulation, oral mucosa, hematopoietic stem cell transplantation.
Collapse
Affiliation(s)
- Yehuda Zadik
- Division of Oral Medicine, Eastman Institute of Oral Health, University of Rochester Medical Center, Rochester, NY 14620,
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Oral complications in hematopoietic stem cell recipients: the role of inflammation. Mediators Inflamm 2014; 2014:378281. [PMID: 24817792 PMCID: PMC4003795 DOI: 10.1155/2014/378281] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/27/2014] [Indexed: 11/30/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is widely used as a potentially curative treatment for patients with various hematological malignancies, bone marrow failure syndromes, and congenital immune deficiencies. The prevalence of oral complications in both autologous and allogeneic HSCT recipients remains high, despite advances in transplant medicine and in supportive care. Frequently encountered oral complications include mucositis, infections, oral dryness, taste changes, and graft versus host disease in allogeneic HSCT. Oral complications are associated with substantial morbidity and in some cases with increased mortality and may significantly affect quality of life, even many years after HSCT. Inflammatory processes are key in the pathobiology of most oral complications in HSCT recipients. This review article will discuss frequently encountered oral complications associated with HSCT focusing on the inflammatory pathways and inflammatory mediators involved in their pathogenesis.
Collapse
|
27
|
Affiliation(s)
- Sandra Regina Torres
- Faculdade de Odontologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| |
Collapse
|
28
|
Gomes AOF, Torres SR, Maiolino A, Dos Santos CWN, Silva Junior A, Correa MEP, Moreira MCR, Gonçalves LDS. Early and late oral features of chronic graft-versus-host disease. Rev Bras Hematol Hemoter 2014; 36:43-9. [PMID: 24624035 PMCID: PMC3948665 DOI: 10.5581/1516-8484.20140012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/20/2013] [Indexed: 12/02/2022] Open
Abstract
Background Chronic graft-versus-host disease is a serious complication of allogeneic hematopoietic cell transplantation, and the mouth is one of the affected sites. Objective The aim of this study was to evaluate the oral features of this disease after hematopoietic cell transplantation. Methods This was a cross-sectional multicenter study that enrolled patients submitted to transplantation. Oral evaluations used the National Institutes of Health criteria, salivary flow rates, and the range of mouth opening. Pain and xerostomia were evaluated through a visual analogue scale. Patients were divided into two groups based on the transplantation time (up to one year and more than one year). Results Of the 57 evaluated recipients, 44 had chronic graft-versus-host disease: ten (22.72%) in the group with less than one year after transplantation, and 34 (77.27%) in the group with more than one year after transplantation. Lichenoid/hyperkeratotic plaques, erythematous lesions, xerostomia, and hyposalivation were the most commonly reported oral features. Lichenoid/hyperkeratotic plaques were significantly more common in patients within the first year after the transplant. The labial mucosa was affected more in the first year. No significant changes occurred in the frequency of xerostomia, hyposalivation, and reduced mouth opening regarding time after transplantation. Conclusion Oral chronic graft-versus-host disease lesions were identified early in the course of the disease. The changes observed in salivary gland function and in the range of mouth opening were not correlated with the time after transplantation. © 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. All rights reserved.
Collapse
Affiliation(s)
| | | | - Angelo Maiolino
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Arley Silva Junior
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil ; Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | | | | | | |
Collapse
|
29
|
Khudhur AS, Di Zenzo G, Carrozzo M. Oral lichenoid tissue reactions: diagnosis and classification. Expert Rev Mol Diagn 2014; 14:169-84. [DOI: 10.1586/14737159.2014.888953] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
30
|
Hanada H, Ohno J, Seno K, Ota N, Taniguchi K. Dynamic changes in cell-surface expression of mannose in the oral epithelium during the development of graft-versus-host disease of the oral mucosa in rats. BMC Oral Health 2014; 14:5. [PMID: 24433462 PMCID: PMC3903439 DOI: 10.1186/1472-6831-14-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background The role of cell-surface glycoconjugates in oral mucosal graft-versus-host disease (GVHD) is still unclear, even though molecular changes in the oral epithelium are essential for the pathogenesis of these lesions. In this study, we investigated changes in the binding of mannose (Man)-specific Lens culinaris lectin (LCA) in the oral mucosa of rats with GVHD. Methods Lewis rat spleen cells were injected into (Lewis x Brown Norway) F1 rats to induce systemic GVHD, including oral mucosal lesions. Tongue and spleen samples were evaluated using lectin histochemistry, immunohistochemistry, Western blotting, transwell migration assays and Stamper-Woodruff binding assays. Results Binding of Man-specific LCA expanded to the epithelial layers of the tongue in GVHD-rats. An expansion of LCA binding was related to the increased expression of mannosyltransferase in the oral mucosa. CD8+ cells, effector cells of oral mucosal GVHD, expressed mannose-binding protein (MBP) and migrated to the medium containing Man in the transwell migration assay. Adherence of CD8+ cells to the oral epithelium could be inhibited by pretreating CD8+ cells with MBP antibody and/or by pretreating sections with Man-specific LCA. Conclusions Increased expression of Man on keratinocytes leads to the migration and/or adhesion of CD8+ cells in the surface epithelium, which is mediated in part by the MBP/Man-binding pathway during the development of oral mucosal GVHD.
Collapse
Affiliation(s)
| | - Jun Ohno
- Department of Morphological Biology, Division of Pathology, Fukuoka Dental College, Tamura, Fukuoka 2-15-1, Japan.
| | | | | | | |
Collapse
|
31
|
Nalamliang N, Tangnantachai N, Thongprasom K. Medications in Thai Patients with Oral Lichen Planus, Oral Lichenoid Drug Reaction and Glossitis. ACTA ACUST UNITED AC 2014. [DOI: 10.5005/jp-journals-10029-1075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ABSTRACT
Introduction
Medications have been widely used in the dental patients for the treatment of their systemic diseases. In fact, those drugs have some side-effects to many organs and also the oral cavity. The aim of our study was to investigate the relationship between medications and oral lichen planus (OLP), oral lichenoid drug reaction (OLDR) and glossitis (GT) in Thai patients.
Materials and methods
One hundred and thirty-eight cases of Thai patients were included in this study. Medical records of all cases with oral lesions and symptoms referred to the oral medicine clinic during 2007 to 2010 were extracted. Oral lichen planus group consisted of 88 cases, GT 26 cases and OLDR 24 cases. All data were analyzed using SPSS for Windows version 11.5.
Results
In our study, 75.5% of patients used more than one medication while single drug used was 24.5%. Antihypertensive drugs were the most commonly used in all groups. Antihypertensive and hypolipidemic drugs were equally taken 22.4% in OLP patients. Patients with OLDR taking antihypertensive in 54.2% followed by hypolipidemic (37.5%), NSAIDs (25%), hypoglycemic/antiplatelet (16.7%) each and others 25%. Patients in GT group were also used antihypertensive drugs 35%, NSAIDs 25%, hypolipidemic 20% respectively.
Conclusion
Most of patients with oral lesions took more than one medication. Antihypertensive drugs were the most commonly used in Thai patients with oral lesions.
How to cite this article
Nalamliang N, Tangnantachai N, Thongprasom K. Medications in Thai Patients with Oral Lichen Planus, Oral Lichenoid Drug Reaction and Glossitis. Int J Experiment Dent Sci 2014;3(2):73-76.
Collapse
|
32
|
Park AR, La HO, Cho BS, Kim SJ, Lee BK, Rhie JY, Gwak HS. Comparison of budesonide and dexamethasone for local treatment of oral chronic graft-versus-host disease. Am J Health Syst Pharm 2013; 70:1383-91. [DOI: 10.2146/ajhp120567] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Ae Ryoung Park
- Department of Pharmacy, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
| | - Hyen Oh La
- Department of Pharmacology, College of Medicine, Catholic University of Korea, and Director, Department of Pharmacy, Seoul St. Mary’s Hospital
| | - Byung Sik Cho
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, College of Medicine, Catholic University of Korea
| | - Soon Joo Kim
- Department of Pharmacy, Seoul St. Mary’s Hospital
| | - Byung Koo Lee
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul
| | - Jeong Yeon Rhie
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul
| | - Hye Sun Gwak
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul
| |
Collapse
|
33
|
The impact of morphological and immunohistological changes in minor salivary glands on the health of the oral cavity in HSCT patients. Bone Marrow Transplant 2013; 48:1525-9. [PMID: 23892328 DOI: 10.1038/bmt.2013.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/09/2013] [Accepted: 06/11/2013] [Indexed: 11/08/2022]
Abstract
The objective of this study was to test the relationship between histological changes in minor salivary glands (MSG) and chronic GVHD (cGVHD) severity and OS of hematopoietic SCT (HSCT) patients, and to discriminate the participation of events preceding HSCT that damage MSG, from those linked to cGVHD. The MSG of 57 HSCT patients who were divided into two groups-oral cGVHD (36 cases) and non-cGVHD (21 cases)-were compared with the MSG of a control group of 19 non-HSCT individuals. cGVHD changes were assessed according to National Institutes of Health (NIH) consensus and the systems of Horn et al. Acinar areas and mononuclear cell subsets were set through morphometry. Horn's 'periductal lymphocytic infiltrate' correlated with an extensive form of cGVHD and NIH 'periductal lymphocytes with exocytosis into duct' correlated with global survival. Measurements of the acinar area differed between the three groups, being the lowest in cGVHD patients, but also reduced in non-cGVHD patients. Significant differences among CD45, CD45RO, CD4 and CD8 immunomarked cells/mm(2) were found by comparing the two groups of HSCT patients. In brief, periductal lymphocytic infiltrate and exocytosis implies inflammatory activity and, consequently, might reflect the cGVHD status and influence survival. Acini loss in non-cGVHD patients may be due to pre-transplant events, but massive lymphocyte infiltrate is part of the cGVHD process.
Collapse
|
34
|
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) has evolved over the past two decades to become the standard of care for hematologic and lymphoid malignancies. Major ocular complications after allogeneic HSCT have been increasing in number and severity. Graft-versus-host disease (GVHD) remains a major cause of ocular morbidity after allogeneic HSCT. The main objective of this review is to elucidate the ocular complications in patients developing GVHD following HSCT. Ocular complications secondary to GVHD are common and include dry eye syndrome, acquisition of ocular allergy from donors with allergic disorders. Eyelid changes may occur in GVHD leading to scleroderma-like changes. Patients may develop poliosis, madarosis, vitiligo, lagophthalmos, and entropion. The cornea may show filamentary keratitis, superficial punctate keratitis, corneal ulcers, and peripheral corneal melting which may lead to perforation in severe cases. Scleritis may also occur which can be anterior or posterior. Keratoconjunctivis sicca appears to be the most common presentation of GVHD. The lacrimal glands may be involved with mononuclear cell infiltration of both the major and accessory lacrimal glands and decrease in tear production. Severe dry eye syndrome in patients with GVHD may develop conjunctival scarring, keratinization, and cicatrization of the conjunctiva. Therapy of GVHD includes systemic immunosuppression and local therapy. Surgical treatment in refractory cases includes surgical intervention to improve the manifestation of GVHD of the eye. This may include tarsorrhapy, prose lenses, punctal occlusions and corneal transplantation.
Collapse
Affiliation(s)
- Amr Nassar
- Adult Hematology/HSCT, King Faisal Cancer Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Khalid F. Tabbara
- The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- Research Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| |
Collapse
|
35
|
Mays JW, Fassil H, Edwards DA, Pavletic SZ, Bassim CW. Oral chronic graft-versus-host disease: current pathogenesis, therapy, and research. Oral Dis 2012; 19:327-46. [PMID: 23107104 DOI: 10.1111/odi.12028] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 09/11/2012] [Accepted: 09/11/2012] [Indexed: 12/13/2022]
Abstract
Optimal management of complex autoimmune diseases requires a multidisciplinary medical team including dentists to care for lesions of the oral cavity. In this review, we discuss the presentation, prevalence, diagnosis, and treatment of oral manifestations in chronic graft-versus-host disease (cGVHD), which is a major late complication in patients treated by allogeneic hematopoietic stem cell transplantation. We assess current general knowledge of systemic and oral cGVHD and present general treatment recommendations based on literature review and our clinical experience. Additionally, we review areas where the understanding of oral cGVHD could be improved by further research and address tools with which to accomplish the long-term goal of providing better health and quality of life to patients with cGVHD.
Collapse
Affiliation(s)
- J W Mays
- Clinical Research Core, National Institute of Dental and Craniofacial Research, Bethesda, MD 20892-4320, USA.
| | | | | | | | | |
Collapse
|
36
|
Elad S, Zeevi I, Finke J, Koldehoff M, Schwerdtfeger R, Wolff D, Mohrbacher R, Levitt M, Greinwald R, Shapira MY. Improvement in Oral Chronic Graft-versus-Host Disease with the Administration of Effervescent Tablets of Topical Budesonide—An Open, Randomized, Multicenter Study. Biol Blood Marrow Transplant 2012; 18:134-40. [DOI: 10.1016/j.bbmt.2011.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 06/01/2011] [Indexed: 10/18/2022]
|
37
|
Palmason S, Marty FM, Treister NS. How Do We Manage Oral Infections in Allogeneic Stem Cell Transplantation and Other Severely Immunocompromised Patients? Oral Maxillofac Surg Clin North Am 2011; 23:579-99, vii. [DOI: 10.1016/j.coms.2011.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
38
|
Shahrabi Farahani S, Treister NS, Khan Z, Woo SB. Oral verruciform xanthoma associated with chronic graft-versus-host disease: a report of five cases and a review of the literature. Head Neck Pathol 2011; 5:193-8. [PMID: 21305367 PMCID: PMC3098333 DOI: 10.1007/s12105-011-0246-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 01/27/2011] [Indexed: 12/18/2022]
Abstract
Verruciform xanthoma (VX) is an uncommon benign inflammatory mucocutaneous condition that chiefly occurs in the oral cavity. It is often associated with pre-existing epithelial and/or inflammatory disorder and is characterized histopathologically by papillary epithelial hyperplasia and the presence of foamy macrophages in connective tissue papillae. We report of a series of five cases with VX who concurrently had chronic oral graft-versus-host disease following hematopoietic stem cell transplantation.
Collapse
|
39
|
Karavana Hizarcioğlu SY, Sezer B, Güneri P, Veral A, Boyacioğlu H, Ertan G, Epstein JB. Efficacy of topical benzydamine hydrochloride gel on oral mucosal ulcers: an in vivo animal study. Int J Oral Maxillofac Surg 2011; 40:973-8. [PMID: 21549562 DOI: 10.1016/j.ijom.2011.02.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 01/11/2011] [Accepted: 02/22/2011] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the effect of benzydamine hydrochloride bioadhesive gel on healing of oral mucosal ulceration in an animal model. For in vivo determination of the effects of the bioadhesive gel, 36 rabbits were separated into three groups: the first group was treated with the gel formulation without active agent, the second group with the gel formulation containing benzydamine, and the third group received no treatment. Clinical healing was established by measuring the area of the ulcer in each test group on days 3, 6, 9 and 12. Histological healing was determined on the same days. Benzydamine containing gel applications resulted in a decrease in the ulcer area in 12 days (p=0.000). Histological evaluation showed that the benzydamine group had a higher mean histological score than the base and the control groups during the whole test period, and the difference between the benzydamine group and the control group was significant (p=0.04). The bioadhesive gel formulation of benzydamine hydrochloride showed a statistically significant increased rate of mucosal repair in this experimental standard mucosal wound animal study. It is a candidate for the topical treatment of oral mucosal ulcerative lesions.
Collapse
|
40
|
|
41
|
Lino VAS, Santos SME, Bittencourt HNDS, Silva ML, Spizziri T, Bretas R, Neves SPF. Quantification of CD8(+)CD38(+) T lymphocytes by flow cytometry does not represent a good biomarker to monitor the reactivation of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation. Rev Bras Hematol Hemoter 2011; 33:268-73. [PMID: 23049317 PMCID: PMC3415765 DOI: 10.5581/1516-8484.20110075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/22/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Infection/reactivation of cytomegalovirus is a major cause of morbidity and mortality in immunocompromised transplant patients. It has already been observed in kidney and liver transplantation patients that cytomegalovirus disease is accompanied by significant increases in circulating CD8(+)CD38(+) T lymphocytes. There are no reports that study CD8(+)CD38(+) T lymphocytes to monitor/diagnose cytomegalovirus disease in hematopoietic stem cell transplantation patients. OBJECTIVE The aim of this study was to evaluate some cellular activation markers on circulating mononuclear cells (CD38 and HLA-DR) in patients submitted to hematopoietic stem cell transplantation and to establish any correlation with cytomegalovirus disease as diagnosed by antigenemia. METHODS Blood samples of 15 transplant patients were analyzed by flow cytometry using anti-CD3, anti-CD4, anti-CD8, anti-CD38, CD16, CD56 and anti-HLA-DR monoclonal antibodies and the results were evaluated in respect to cytomegalovirus antigenemia measured by indirect immunofluorescence. Minitab for Windows was used for statistical analysis and a p-value < 0.05 was considered significant. RESULTS Patients with positive antigenemia did not show any significant increase in the percentages of cells expressing the CD38 or HLADR activation markers when compared to patients with negative antigenemia. On the contrary, all patients showed high percentages of these cells independent of the presence of cytomegalovirus disease. CONCLUSIONS This study suggests that the investigation of these lymphocyte sub-populations in patients submitted to hematopoietic stem cell transplantation does not seem to contribute to the early identification of cytomegalovirus disease.
Collapse
|
42
|
Meier JKH, Wolff D, Pavletic S, Greinix H, Gosau M, Bertz H, Lee SJ, Lawitschka A, Elad S. Oral chronic graft-versus-host disease: report from the International Consensus Conference on clinical practice in cGVHD. Clin Oral Investig 2010; 15:127-39. [PMID: 20859645 DOI: 10.1007/s00784-010-0450-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Accepted: 07/26/2010] [Indexed: 01/12/2023]
Abstract
Chronic graft-versus-host disease (cGVHD) is a multi-organ disease that occurs post-hematopoietic stem cell transplantation, with the mouth being one of the most frequently affected organs. In 2009, the German-Austrian-Swiss working party on bone marrow and blood stem cell transplantation held a consensus conference to define clinical management of cGVHD. The consensus conference aimed to summarize the literature on diagnosis and topical treatment options for oral cGVHD and to provide recommendations for clinical practice, including routine dental and oral care as well as monitoring for secondary malignancies and bisphophonate-induced osteonecrosis of the jaw.
Collapse
Affiliation(s)
- Johannes K-H Meier
- Department of Cranio-Maxillo-Facial Surgery, University of Regensburg, Regensburg, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Elad S, Zeevi I, Or R, Resnick IB, Dray L, Shapira MY. Validation of The National Institutes of Health (NIH) Scale for Oral Chronic Graft-versus-Host Disease (cGVHD). Biol Blood Marrow Transplant 2010; 16:62-9. [DOI: 10.1016/j.bbmt.2009.08.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 08/27/2009] [Indexed: 12/12/2022]
|
44
|
Xerostomia and chronic oral complications among patients treated with haematopoietic stem cell transplantation. Br Dent J 2009; 207:E17; discussion 428-9. [DOI: 10.1038/sj.bdj.2009.977] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2009] [Indexed: 12/23/2022]
|
45
|
Combined topical dexamethasone/tacrolimus therapy for management of oral chronic GVHD. Bone Marrow Transplant 2009; 45:1062-7. [DOI: 10.1038/bmt.2009.301] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
46
|
Epstein JB, Raber-Durlacher JE, Raber-Drulacher JE, Wilkins A, Chavarria MG, Myint H. Advances in hematologic stem cell transplant: an update for oral health care providers. ACTA ACUST UNITED AC 2009; 107:301-12. [PMID: 19217013 DOI: 10.1016/j.tripleo.2008.12.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 10/30/2008] [Accepted: 12/02/2008] [Indexed: 12/20/2022]
Abstract
Oral supportive care is critical in the management of patients receiving hematopoietic cell transplantation (HCT). Advances in HCT, such as the use of stem cells isolated from peripheral blood instead of bone marrow, have resulted in more rapid engraftment and thus a shorter duration of pancytopenia. Reduced-intensity conditioning regimens, associated with less toxicity, make HCT available to older patients and patients with comorbidities. These new developments have led to increased transplant rates and an altered spectrum of therapy-related complications, such as mucositis, and to shifts in the prevalence and pattern of occurrence of infections and graft-versus-host disease. The purpose of this paper is to review the main principles of HCT and to update dental providers on new technologies being applied to transplantation that may influence oral complications and oral care.
Collapse
Affiliation(s)
- Joel B Epstein
- Department of Oral Medicine and Diagnostic Sciences, University of Illinois, and Illinois Masonic Hospital, Chicago, Illinois 60612, USA.
| | | | | | | | | | | |
Collapse
|
47
|
Increased T-bet+ cytotoxic effectors and type I interferon-mediated processes in chronic graft-versus-host disease of the oral mucosa. Blood 2009; 113:3620-30. [PMID: 19168793 DOI: 10.1182/blood-2008-07-168351] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although chronic graft-versus-host disease (cGVHD) is a major long-term complication of allogeneic hematopoietic stem cell transplantation, little is known of its pathogenesis. We have systematically examined oral mucosa among cGVHD patients and determined that the clinical severity of oral cGVHD was correlated with apoptotic epithelial cells, often found adjacent to infiltrating effector-memory T cells expressing markers of cytotoxicity and type I cytokine polarization. Accumulation of T-bet(+) T-cell effectors was associated with both increased proliferation and the expression of the type I chemokine receptor CXCR3. Concurrently, in both infiltrating cells and keratinocytes, we observed increased expression of the CXCR3 ligand MIG (CXCL9) and interleukin-15 (IL-15), type I interferon (IFN)-inducible factors that support the migration, type I differentiation, and expansion of alloreactive effectors. In severely affected mucosa, we observed high levels of MxA, a protein specifically induced by type I IFN, and signal transducer and activator of transcription 1 (STAT1) phosphorylation, a critical step in the IFN-signaling pathway, along with increased numbers of plasmacytoid dendritic cells. These data challenge the current paradigm of cGVHD as a type II cytokine-driven disorder and support the model that oral cGVHD results from type I IFN-driven immigration, proliferation, and differentiation of T-bet(+) type I T effectors. The clinical trials are registered at http://www.clinicaltrials.gov as NCT00331968.
Collapse
|
48
|
Orti-Raduan ÉSL, Nunes AJF, Oliveira DT, Lara VS, De Assis Taveira LA. Quantitative analysis of Langerhans’ cells in oral chronic graft-vs.-host disease. J Oral Pathol Med 2008; 38:132-7. [DOI: 10.1111/j.1600-0714.2008.00712.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
49
|
Imanguli MM, Alevizos I, Brown R, Pavletic SZ, Atkinson JC. Oral graft-versus-host disease. Oral Dis 2008; 14:396-412. [PMID: 18593456 DOI: 10.1111/j.1601-0825.2008.01448.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Graft-versus-host disease (GVHD) is a leading cause of morbidity and mortality in patients receiving hematopoietic cell transplant. It is estimated that 40-70% of engrafted patients surviving the initial transplant eventually develop chronic GVHD (cGVHD), which can persist for months to years and require long-term management from multiple disciplines. This review describes the oral component of this transplant complication. DESIGN The search related to GVHD patho-biology, salivary gland disease after hematopoietic cell transplant and treatments for oral GVHD encompassed literature from 1966 through 2008. Searches were limited to the MEDLINE/PubMed database and English language literature in peer-reviewed journals. RESULTS Our understanding of the patho-biology of oral cGVHD is based on studies of other affected tissues. It is difficult to determine the prevalence and incidence of salivary gland disease after transplant because there is no universally accepted case definition. In general, clinical trials for treatment of oral cGVHD have been too small to make strong recommendations for use in clinical practice. CONCLUSIONS Larger well-designed clinical studies are needed to understand the patho-biology of oral cGVHD and determine best treatments for this disease.
Collapse
Affiliation(s)
- M M Imanguli
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | | | | | | | | |
Collapse
|
50
|
Nozaki-Taguchi N, Shutoh M, Shimoyama N. Potential utility of peripherally applied loperamide in oral chronic graft-versus-host disease related pain. Jpn J Clin Oncol 2008; 38:857-60. [PMID: 18952705 DOI: 10.1093/jjco/hyn110] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Four patients with oral chronic graft-versus-host disease pain were treated with loperamide oral-rinse solution. Two-week continued use of the drug solution improved not only the pain scores but also the pain-causing disabilities associated with eating, drinking and sleeping, with no noticeable side effects. Current results suggest that the mu-opioid agonist, loperamide, has a potential analgesic effect that could be clinically used as a peripheral analgesic agent for stomatitis pain. However, these observations will need to be further confirmed in a randomized-controlled trial.
Collapse
Affiliation(s)
- Natsuko Nozaki-Taguchi
- Department of Anesthesiology and Palliative Medicine, Chiba University Graduate School of Medicine, Chuo, Chiba, Japan.
| | | | | |
Collapse
|