Graft-versus-Host Disease: Mouth

Summary: Chronic graft-versus-host disease (GVHD) of the mouth is a common side-effect of stem cell transplantation. This presentation describes the major types or oral GVHD and discusses the most effective remedies to treat this problem.
Presenter: Nathanial Treister DMD, DMSc, Brigham and Women's Hospital and Dana-Farber Cancer Institute
Many thanks to Incyte whose support helped make this Survivorship Symposium possible.
To read the transcript, go to:
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Highlights:
Oral GVHD can affect the salivary glands which can cause yeast infections, make it difficult to eat, and lead to cavities and other dental problems.
Topical steroids like a dexamethasone solution are often the best treatment for oral GVHD. If they are not effective, corticosteroids with higher potency such as clobetasol and budesonide can be used as well.
Patients with chronic GVHD of the mouth are at increased risk for cancers of the mouth. If they have persistent sores that do not respond to conventional treatment, follow up care may include a biopsy to screen for oral cancer.
May 2024, Part of the Virtual Celebrating a Second Chance at Life Survivorship Symposium 2024
Presentation is 43 minutes long with 15 minutes of Q & A.
Key Points:
(04:36): The most prominent manifestation of oral GVHD is a rash-like change on the inside of the mouth called lichenoid inflammation, which can be quite painful. Chronic oral GVHD can also affect the lips.
(06:35): When oral GVHD affects the salivary glands, it can produce a very dry mouth that makes eating difficult and can cause cavities.
(10:55): Oral GVHD may last for years, even when GVHD symptoms are no longer occurring in other parts of the body.
(11:44): Symptoms of oral GVHD are often similar to other oral diseases like oral lichen planus, Sjogren’s syndrome, or scleroderma.
(17:29): Oral GVHD can cause thickening of tissues inside the mouth, making it difficult to fully open the mouth.
(21:34): Clobetasol and budesonide, more potent steroids than dexamethasone, is sometimes used to treat oral GVHD.
(22:12): Tacrolimus as a topical ointment works well to treat GVHD on the lips.
(26:53): Systemic antifungal medications can often be more effective than topical treatments for chronic oral GVHD.
(32:53): There are several over the counter and prescription medications to hydrate the mouth and stimulate salivary glands.
(34:24): Prescription-strength fluoride gel is one of our best weapons against cavities.
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