An overview of chronic oral graft-vs-host disease following pediatric hematopoietic stem cell transplantation.

Hematopoietic stem cell transplant (HSCT) is the treatment of choice for many hematologic, genetic, oncologic, and immunologic diseases. It is also one of the most aggressive treatments among the different cancer therapies, however, and is associated with severe conditioning-related toxicity, profound neutropenia, a high level of prophylactic immunosuppression and graft-vs-host disease (GVHD). Even with GVHD prophylaxis, chronic GVHD remains a significant complication of HSCT and is a frequent reason for nonrelapse morbidity and mortality following allogeneic HSCT. It primarily targets the skin, gastrointestinal tract, and liver. Approximately 20% of patients who receive matched sibling transplants and 40% of matched unrelated donor recipients will develop chronic GVHD. Risk factors include: (1) history of acute GVHD; (2) hemotologic malignancy; (3) female donor to male recipient; (4) use of total body irradiation; (5) donor age of > or = 5 years; and (6) recipients >10 years of age. The purpose of this paper was to review the pathogenesis, prevention, and treatment of pediatric chronic graft-vs-host disease, with a focus on its oral manifestations and the dental management of affected children and adolescents.