Supplementary Material for: Oral chronic graft-versus-host disease (cGVHD) in post-hematopoietic stem cell transplant (post-HCT) patients following SARS-CoV-2 vaccination: Case reports

Patients receiving allogeneic hematopoietic stem cell transplant (HCT) may experience graft-versus-host disease (GVHD) in which donor immune cells cause an immune reaction in host tissues. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccines are highly effective in prevention of severe Coronavirus-2019 (COVID-19) disease, but the vaccine can result in immune activation and GVHD. Herein we report four cases of oral manifestations that may have been stimulated by COVID-19 or vaccination with Pfizer or Moderna vaccines. We believe this study is the first to report oral changes driven by an inflammatory/immune mechanism leading to oral symptomatic cGVHD. The clinical impact of this study is early recognition and appropriate management of oral symptomatic cGVHD following COVID-19 disease or SARS-CoV-2 vaccination.