Oral features of graft-versus-host disease*

Chronic graft-versus-host disease (cGVHD) is a late complication of allogeneic hematopoietic stem cell transplant (HSCT), occurring in 18% to 70% of recipients.1-3 The oral tissues may be involved in up to 90% of the patients that present cGVHD in other organs.4-10 Oral mucosa lesions and salivary gland dysfunction are the main manifestations of oral cGVHD, but a reduction of the mouth opening due to the perioral deposition of collagen may also occur.10 Patients with oral involvement of cGVHD may present sensitivity, pain, xerostomia, and dysgeusia,10-12 and the severity of the oral manifestations may be associated to the severity of the disease.5 The sites of the oral mucosa most commonly involved by the lesions are the buccal mucosa and the tongue.10,13-15 The diagnosis of the oral lesions is based on clinical aspects. However, a biopsy of the oral mucosa and/or minor salivary glands may be requested when oral and systemic signs and symptoms are not sufficient for the diagnosis of cGVHD.5 According to the National Institutes of Health (NIH), the oral features of cGVHD may be classified as diagnostic (lichen planus-like changes, hyperkeratotic plaques, and reduction in mouth opening), distinctive (xerostomia, mucoceles, mucosal atrophy, pseudomembranes, and ulcers), and common to both acute graft-versus-host disease and cGVHD (gingivitis, mucositis, erythema, and pain).16-18 The NIH criteria consider certain subjective data, such as xerostomia and reduction of mouth opening. However, some patients with reduced salivary flow rates and reduced range of mouth opening do not present these symptoms.10 Thus, a definition of hyposalivation and the Scientific comment