Oral Chronic Graft-versus-host Disease

Oral chronic graft-versus-host disease (cGVHD) is a frequent and principal adverse effect of allogeneic hematopoietic cell transplantation (alloHCT). It is an important factor of morbidity in long-term alloHCT survivors. Oral manifestations of GVHD include inflammation, thinning of oral tissue, and ulceration (similar to lichen planus), lymphocyte-mediated salivary gland dysfunction (similar to Sjögren syndrome), sclerosis of oral and perioral tissues which leads to limitation in oral opening (trismus) (equivalent to decreased oral opening in scleroderma). These pathological events can lead to severe mucosal pain, malnutrition, weight loss, trismus, and in some cases irreversible salivary glands fibrosis. Pain is the most prominent symptom of oral cGVHD which can severely affect the patient’s quality of life. The pain may strongly impair basic physiological oral functions such as eating, drinking, and speech. The severe pain may lead to nutritional compromise, weight loss, dehydration, enteral or parenteral nutrition, opioid consumption and hospitalizationMedication selection; including selection of topical or systemic treatment or both, is based on the severity of oral lesions, degree of functional impairment, patient specific factors, medication potency, availability, cost and patient preference. While some mild cases can be managed with topical therapies, management may also require long-term targeted immunosuppressive and/or corticosteroid therapy with associated risks. Topical treatment is an essential part of oral cGVHD management. In more severe cases systemic treatment is recommended. Even when systemic treatment is needed, topical therapies are valuable as combination therapy. Currently no FDA-approved topical therapies exist for oral cGVHD. Topical steroids, topical non-steroidal agents (e.g., tacrolimus, cyclosporine, thalidomide, azathioprine, some traditional agents, etc), topical anesthetics, PUVA and UVB have been used in clinical practice. Due to the anti-inflammatory and analgesic properties of photobiomodulation therapy (low level laser therapy), PBMT can be used as an adjunctive option for management of oral cGVHD. In this panel we will discuss about the different aspects of PBM application in oral cGVHD. The beneficial effects of photobiomodulation therapy (low level laser therapy) has been investigated for pain relief and inflammation reduction of oral GVHD.