1547 Oral Graft-versus-Host Disease: Clinical Presentation, Predictive Factors and Significance

Saturday, March 24, 2012: 9:45 a.m. - 11 a.m.
Presentation Type: Poster Session
H. FASSIL1, C. BASSIM2, D. EDWARDS3, K. BAIRD4, S.M. STEINBERG5, S. MITCHELL6, L. GRKOVIC1, D. ZHANG5, and S. PAVLETIC1, 1Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD, 2National Institute for Dental Craniofacial Research, NIH, Bethesda, MD, 3National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD, 4Pediatric Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, 5Center for Cancer Research, Biostatistics and Data Management Section, National Cancer Institute, NIH, Bethesda, MD, 6Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, MD

To evaluate the clinical presentation, laboratory markers and significance of oral chronic graft-versus-host disease (cGVHD).


187 patients with cGVHD following allogeneic hematopoietic stem cell transplantation (HSCT) were enrolled in a cross-sectional natural history study protocol of cGVHD at the NIH from 2004-2011. Intraoral examinations performed by clinicians experienced in cGVHD utilized the NIH 15-point oral cGVHD activity assessment scale to assess oral mucosal changes.

Participants with total oral mucosal change scores of 3-15 were categorized as “oral GVHD” and participants with scores of 0-2 as “non-oral GVHD”. The two groups were compared based on demographic, transplant and cGVHD characteristics, laboratory parameters, and patient reported symptoms measures.

Initial univariate analyses were performed and factors associated with oral cGVHD (p<0.05) were included in multivariate logistic regression models.


Oral cGVHD presented in 44(24%) of patients and occurred most commonly with quiescent or de-novo type of cGVHD onset (p=0.0495), higher NIH average score (p=0.033), lower albumin levels (p=0.0008), higher total complement (p=0.012), and led to greater bother from avoidance of foods (p<0.0001) or oral ulcers (p<0.0001), greater mouth pain (p<0.0001) and sensitivity (p<0.0001).

A final multivariable logistic model, as determined by backward selection, indicated that albumin (p<0.0001), total complement (p=0.0046) and mouth pain (p<0.0001) were jointly associated with oral cGVHD. This model predicted correct classification for 74.3% of oral GVHD and 80.2% of non-oral GVHD patients.


Chronic GVHD is a clinical syndrome after allogeneic HSCT and the leading cause of morbidity and mortality amongst transplant survivors. Oral cGVHD causes mucosal, salivary and/or sclerotic changes, and is associated with oral related pain and discomfort. The precise characterization and ability to accurately predict oral cGVHD, based on future confirmatory application of our model to the ongoing cGVHD study, will enable further development of effective therapeutic and preventive strategies for oral cGVHD. 


Table 1: Demographic Characteristics of NIH cGVHD Cohort. 

Total Number of Patients                                     187  

Median number of days from transplant                       218

to  GVHD diagnosis                                      (range 0-2058)

Total Number Oral cGVHD                                  44

Conditioning Regimen

  Myeloablative                                                  106 (57%)

  Total Body Irradiation (TBI)                             72 (39%)

Median Age                                                        45.6

                                                         (range 3.7-69.8)


  Male                                                          103 (55%)

  Female                                                        84 (45%)

Donor Relationship

  Unrelated                                                           72 (39%)

  Related                                                             113 (61%)


  ALL/AML/MDS                                         79 (46%)

  CML                                                            26 (15%)

  CLL                                                               12 (7%)

  Lymphoma                                                  35 (20%)

  Multiple Myeloma                                        10 (6%)

  Sarcoma                                                       1 (0.5%)

  Aplastic Anemia/PNH                                   6 (4%)

  Immunodeficiency                                         2 (1%)

  Other non-malignant                                   1 (0.5%)

Gender match recipient-donor

  M/M                                                                   51 (30%)

  M/F                                                                    43 (25%)

  F/F                                                                     36 (21%)

  F/M                                                                    39 (23%)

Cell Source

  Bone Marrow                                                     35 (19%)

  Peripheral Blood                                              146 (79%)

  Cord Blood                                                            4 (2%)                     

HLA Matched

  Yes                                                                   148 (82%)

  No                                                                      32 (18%)

For all values in above table, continuous variables are shown as median values with ranges and categorical variables are shown as frequencies with percentages


Table 2: Variables Significantly Associated with Oral cGVHD


Non-Oral cGVHD

Oral cGVHD


Patient, transplant and cGVHD characteristics

   Quiescent or de novo cGVHD Onset

79/138 (57.2%)

33/44 (75%)


   NIH average score

1.02 (0.03)

1.21 (0.07)


Laboratory Parameters


3.7 (0.04)

3.43 (0.07)


   Total Complement

132.05 (3.35)

148.25 (5.99)


Patient-reported measures

    Bother by avoidance of certain foods due to mouth pain

50/117 (42.7%)

30/36 (83.3%)

< .0001

   Bother by ulcers in mouth

37/117 (31.6%)

24/36 (66.7%)

< 0.0001

   Mouth Pain

1.1 (0.21)

3.83 (0.56)

< 0.0001

   Mouth Sensitivity

(2.12 (0.28)

4.17 (0.53)

< 0.0001

For each of the groups, oral and non-oral cGVHD, continuous variables are shown as means and standard deviations. Categorical variables are shown as proportions with percentages for each group.

This abstract is based on research that was funded entirely or partially by an outside source: NIH/NCI

Keywords: Diagnosis, Immunology, Oral medicine, Oral mucosa and Pain
See more of: Mucosal disease
See more of: Oral Medicine & Pathology