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  • Tollemar, VictorKarolinska Institutet (author)

Histopathological Grading of Oral Mucosal Chronic Graft-versus-Host Disease : Large Cohort Analysis

  • Article/chapterEnglish2020

Publisher, publication year, extent ...

  • Elsevier,2020
  • electronicrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:mau-18018
  • https://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-18018URI
  • https://doi.org/10.1016/j.bbmt.2020.06.031DOI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-424538URI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:144979574URI

Supplementary language notes

  • Language:English
  • Summary in:English

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Classification

  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Graft-versus-host disease (GVHD) can manifest as acute or chronic complications in patients after hematopoietic cell transplantation (HCT). Oral chronic GVHD (cGVHD) occurs in approximately 70% of HCT recipients and includes lichenoid-like mucosal reactions, restricted mouth opening, and salivary gland dysfunction. However, the underlying histopathological presentation remains to be validated in large cohorts. We characterized the histopathological features of oral mucosal cGVHD and devised a scoring model in a large patient cohort (n = 112). Oral mucosal biopsy sections (n = 303) with and without oral cGVHD were identified from archived and current HCT recipients with additional healthy controls. Histological screening was performed on hematoxylin and eosin-stained and periodic acid-Schiff-stained sections. A points-based grading tool (0 to 19, grade 0 to IV) was established based on intraepithelial lymphocytes and band-like inflammatory infiltrate, atrophic epithelium with basal cell liquefaction degeneration, including apoptosis, as well as separation of epithelium and pseudo-rete ridges. Validation involved 62 biopsy specimens, including post-HCT (n = 47) and healthy (n = 15) specimens. Remaining biopsy specimens (n = 199) were blindly graded by 3 observers. Histological severity was correlated with clinical diagnostic and distinctive features, demonstrating a spectrum of individual patient severity, including frequent signs of subclinical GVHD in healthy mucosa. However, oral cGVHD presented with significantly higher (P < .001) scores compared with HCT controls, with moderate to high positive likelihood ratios for inflammatory infiltrate, exocytosis, and basal membrane alterations. The grade II-IV biopsy specimens demonstrated a histopathological diagnosis of active mucosal lichenoid-like cGVHD, highlighting the importance of correlating clinical presentation with the dynamic histopathological processes for improved patient stratification. In addition, this tool could be used for assessing treatments, pathological processes, and immune cellular content to provide further insight into this debilitating disease.

Subject headings and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Tudzarovski, NikcoleKarolinska Institutet (author)
  • Warfvinge, GunnarMalmö universitet,Odontologiska fakulteten (OD),Malmö Univ, Fac Odontol, Dept Oral Pathol, Malmö, Sweden(Swepub:mau)odguwa (author)
  • Yarom, NaomOral Medicine Unit, Sheba Medical Center, Tel-Hashomer, Israel; School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel,Sheba Med Ctr, Oral Med Unit, Tel Hashomer, Israel.;Tel Aviv Univ, Sch Dent Med, Tel Aviv, Israel (author)
  • Remberger, MatsUppsala universitet,Hematologi,Uppsala Univ Hosp, Clin Res & Dev Unit, Uppsala, Sweden(Swepub:uu)matre804 (author)
  • Heymann, RobertKarolinska Institutet (author)
  • Garming Legert, KarinKarolinska Institutet (author)
  • Sugars, Rachael VKarolinska Institutet (author)
  • Karolinska InstitutetOdontologiska fakulteten (OD) (creator_code:org_t)

Related titles

  • In:Biology of blood and marrow transplantation: Elsevier26:10, s. 1971-19791083-87911523-6536

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