Treatment of oral chronic graft-versus-host disease: a retrospective cohort study

ABSTRACT Objective The aim of this study was to evaluate patients with complete response of oral chronic graft-versus-host disease to immunosuppressive treatment. Methods A total of 29 patients submitted to allogeneic hematopoietic stem cell transplantation, with oral chronic graft-versus-host disease, were enrolled in this retrospective study, from September 2012 to February 2018. Patients were treated with combined topical dexamethasone solution and topical tacrolimus ointment, combined topical dexamethasone and topical tacrolimus, systemic immunosuppressive medication, and topical dexamethasone only. Results The mean time of complete response of lichenoid lesions, erythema, and ulcers using dexamethasone and systemic immunosuppressive medication was of 105, 42 and 42 days, respectively (p=0.013).When we associated dexamethasone, tacrolimus and systemic immunosuppressive medication, the mean time of complete response of lichenoid lesions, erythema and ulcers was of 91,84 and 77 days (p=0.011). When dexamethasone was used alone, the mean time of complete response of lichenoid lesions, erythema and ulcers was 182, 140, 21 days, respectively (p=0.042). Conclusion Our study shows that lichenoid lesions require more time to heal. Notably, lichenoid lesions tend to respond better to dexamethasone combined with tacrolimus and systemic immunosuppressive medication, whereas erythema and ulcers respond better to dexamethasone combined with systemic immunosuppressive medication and dexamethasone only, respectively.

摘要
研究目的：本研究旨在评估口腔慢性移植物抗宿主病（oral chronic graft-versus-host disease）患者对免疫抑制治疗的完全应答（complete response）情况。
研究方法：本回顾性研究于2012年9月至2018年2月期间，纳入29例接受异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation）后发生口腔慢性移植物抗宿主病的患者。所有患者分别接受四种治疗方案：局部地塞米松溶液（topical dexamethasone solution）联合局部他克莫司软膏（topical tacrolimus ointment）、局部地塞米松联合局部他克莫司、全身免疫抑制治疗（systemic immunosuppressive medication），以及单纯局部地塞米松治疗。
研究结果：接受地塞米松联合全身免疫抑制治疗的患者，其苔藓样病变（lichenoid lesions）、红斑（erythema）及溃疡（ulcers）达到完全应答的平均时间分别为105天、42天及42天（p=0.013）。当采用地塞米松、他克莫司联合全身免疫抑制治疗方案时，上述三类病变达到完全应答的平均时间分别为91天、84天及77天（p=0.011）。而仅使用地塞米松单独治疗时，苔藓样病变、红斑及溃疡的完全应答平均时间分别为182天、140天及21天（p=0.042）。
研究结论：本研究显示，苔藓样病变的愈合所需时间更长。值得注意的是，苔藓样病变对地塞米松联合他克莫司及全身免疫抑制治疗的应答效果更佳；而红斑与溃疡则分别对“地塞米松联合全身免疫抑制治疗”与“单纯局部地塞米松治疗”的应答效果更好。