Clinical and histopathological features of the oral mucosa in allogeneic haematopoietic stem cell transplantation patients

Introduction: Chronic graft-versus-host disease (c-GVHD) is a common but serious complication of allogeneic haematopoietic stem cell transplantation (HSCT). Oral involvement of c-GVHD occurs in 80 to 100% of patients suffering from c-GVHD and may be the early manifestation of this complication. Aim: To study whether the histological changes of oral c-GVHD are detectable in apparently normal oral mucosa of HSCT patients without clinical manifestations of the disease. Patients and Methods: This study enrolled 13 adult patients who underwent allogeneic HSCT for haematological malignancies. The presence of lichenoid, atrophic or erythematous changes of the oral mucosa detected on oral examination approximately 100 days after the HSCT was regarded as positive for c-GVHD. An incisional biopsy of the oral mucosa was taken from patients with and without oral c-GVHD and the specimens were examined by a pathologist who was unaware of the clinical state of the sampled mucosa. Results: Biopsies were taken from four patients with clinical manifestations of oral c-GVHD and from nine patients with apparently normal oral mucosa. Histological c-GVHD changes were detected in each of the four patients (100%) with clinical manifestations of oral c-GVHD and in six of the nine patients (66.6%) with apparently healthy mucosa. Discussion: Although the histological changes in the oral mucosa without corresponding clinical alterations that were detected in this study are insufficient for a definite diagnosis of oral c-GVHD, it appears important to investigate the amount of histological change in predicting clinical onset. A longer follow-up period in patients showing histological changes with no clinical manifestations may elucidate whether these changes are predictive of clinically evident lesions in the mouth or other sites. Copyright