Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Alternative Therapies with Tacrolimus and Low-Dose Doxycycline for Oral Chronic Graft-versus-Host Disease That Is Resistant to Topical Corticosteroid Medication: Case Report

  • Ju, Hye-Min (Department of Oral Medicine, Pusan National University Dental Hospital) ;
  • Ahn, Yong-Woo (Dental Research Institute, Pusan National University Dental Hospital) ;
  • Ok, Soo-Min (Dental Research Institute, Pusan National University Dental Hospital) ;
  • Jeong, Sung-Hee (Dental Research Institute, Pusan National University Dental Hospital)
  • Received : 2018.02.06
  • Accepted : 2018.03.02
  • Published : 2018.03.30
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Abstract

Graft-versus-host disease (GVHD) is frequent complications of hematopoietic stem cell transplantation. In the chronic GVHD (cGVHD), the oral cavity is the most commonly affected region. The clinical manifestations include erythema, ulceration, lichenoid-hyperkeratotic change in oral mucosa, dry mouth, and limitation of mouth opening. The initial treatment strategy of oral cGVHD patients is topical corticosteroid therapy in various formulation. However, corticosteroid resistance appears in some patients. We report a case of a 25-year-old male patient with oral cGVHD, who has resistance to topical corticosteroid medication, treated with 0.03% tacrolimus ointment and low-dose doxycycline. The patient showed subjective and objective improvement without side effect.

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References

  1. Kuten-Shorrer M, Woo SB, Treister NS. Oral graft-versus-host disease. Dent Clin North Am 2014;58:351-368. https://doi.org/10.1016/j.cden.2013.12.007
  2. Mays JW, Fassil H, Edwards DA, Pavletic SZ, Bassim CW. Oral chronic graft-versus-host disease: current pathogenesis, therapy, and research. Oral Dis 2013;19:327-346. https://doi.org/10.1111/odi.12028
  3. Margaix-Munoz M, Bagan JV, Jimenez Y, Sarrion MG, Poveda-Roda R. Graft-versus-host disease affecting oral cavity. A review. J Clin Exp Dent 2015;7:e138-e145.
  4. Eckardt A, Starke O, Stadler M, Reuter C, Hertenstein B. Severe oral chronic graft-versus-host disease following allogeneic bone marrow transplantation: highly effective treatment with topical tacrolimus. Oral Oncol 2004;40:811-814. https://doi.org/10.1016/j.oraloncology.2004.02.003
  5. Jaglowski SM, Devine SM. Graft-versus-host disease: why have we not made more progress? Curr Opin Hematol 2014;21:141-147. https://doi.org/10.1097/MOH.0000000000000026
  6. Wolff D, Schleuning M, von Harsdorf S, et al. Consensus conference on clinical practice in chronic GVHD: second-line treatment of chronic graft-versus-host disease. Biol Blood Marrow Transplant 2011;17:1-17. https://doi.org/10.1016/j.bbmt.2010.05.011
  7. Bassim CW, Fassil H, Mays JW, et al. Validation of the national institutes of health chronic GVHD oral mucosal score using component-specific measures. Bone Marrow Transplant 2014;49:116-121. https://doi.org/10.1038/bmt.2013.137
  8. Blazar BR, Murphy WJ, Abedi M. Advances in graft-versus-host disease biology and therapy. Nat Rev Immunol 2012;12:443-458. https://doi.org/10.1038/nri3212
  9. Dhir S, Slatter M, Skinner R. Recent advances in the management of graft-versus-host disease. Arch Dis Child 2014;99:1150-1157. https://doi.org/10.1136/archdischild-2013-304832
  10. Jagasia MH, Greinix HT, Arora M, et al. National institutes of health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. the 2014 diagnosis and staging working group report. Biol Blood Marrow Transplant 2015;21:389-401.e1. https://doi.org/10.1016/j.bbmt.2014.12.001
  11. Albert MH, Becker B, Schuster FR, et al. Oral graft vs. host disease in children--treatment with topical tacrolimus ointment. Pediatr Transplant 2007;11:306-311. https://doi.org/10.1111/j.1399-3046.2006.00666.x
  12. Mawardi H, Stevenson K, Gokani B, Soiffer R, Treister N. Combined topical dexamethasone/tacrolimus therapy for management of oral chronic GVHD. Bone Marrow Transplant 2010;45:1062-1067. https://doi.org/10.1038/bmt.2009.301
  13. Gu Y, Walker C, Ryan ME, Payne JB, Golub LM. Non-antibacterial tetracycline formulations: clinical applications in dentistry and medicine. J Oral Microbiol 2012;4:19227. https://doi.org/10.3402/jom.v4i0.19227
  14. Williams HC, Wojnarowska F, Kirtschig G, et al. Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic, non-inferiority, randomised controlled trial. Lancet 2017;389:1630-1638. https://doi.org/10.1016/S0140-6736(17)30560-3