Measurement of oral chronic GVHD: results from the Chronic GVHD Consortium

• Published in: Bone marrow transplantation (Basingstoke) Vol. 48; no. 8; pp. 1123 - 1128
• Main Authors: Treister, N, Chai, X, Kurland, B, Pavletic, S, Weisdorf, D, Pidala, J, Palmer, J, Martin, P, Inamoto, Y, Arora, M, Flowers, M, Jacobsohn, D, Jagasia, M, Arai, S, Lee, S J, Cutler, C
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.08.2013; Nature Publishing Group
• Subjects: 631/250/1904; 692/699/249/1529; 692/700; Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cell Biology; Child; Child, Preschool; Chronic Disease; Clinical trials; Cohort Studies; Consortia; Erythema; Female; Graft versus host reaction; Graft vs Host Disease - diagnosis; Graft vs Host Disease - etiology; Graft vs Host Disease - pathology; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mouth Diseases - diagnosis; Mouth Diseases - etiology; Mouth Diseases - pathology; National Institutes of Health (U.S.); original-article; Patients; Prospective Studies; Public Health; Quality of Life; Signs and symptoms; Stem cell transplantation; Stem Cells; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; United States; Young Adult; United States; oral cavity; GVHD; quality of life; SCT; Immunopathology; Oral cavity; Graft versus host disease; Chronic; Hematology; Stem cell; Hematopoietic cell; Quality of life
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2012.285

Oral chronic GVHD (cGVHD) is a serious complication of alloSCT. Scales and instruments to measure oral cGVHD activity and severity have not been prospectively validated. The objective of this study was to describe the characteristics of oral cGVHD and determine the measures most sensitive to change. Patients enrolled in the cGVHD Consortium with oral involvement were included. Clinicians scored oral changes according to the National Institutes of Health (NIH) criteria, and patients completed symptom and quality-of-life measures at each visit. Both rated change on an eight-point scale. Of the 458 participants, 72% ( n =331) had objective oral involvement at enrollment. Lichenoid change was the most common feature ( n =293; 89%). At visits where oral change could be assessed, 50% of clinicians and 56% of patients reported improvement, with worsening reported in 4–5% for both the groups (weighted kappa=0.41). Multivariable regression modeling suggested that the measurement changes most predictive of perceived change by clinicians and patients were erythema and lichenoid, NIH severity and symptom scores. Oral cGVHD is common and associated with a range of signs and symptoms. Measurement of erythema and lichenoid changes and symptoms may adequately capture the activity of oral cGVHD in clinical trials but require prospective validation.