Long Term Oral Health Outcomes in the Chronic GVHD Consortium

慢性 GVHD 联盟的长期口腔健康结果

• 批准号: 10664053
• 负责人: Herve Y Sroussi
• 金额: $ 70.97万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10664053
• 关键词: Address; Affect; Allogenic; Biological Specimen Banks; Calibration; Cells; Clinical; Clinical Data; Collaborations; Dana-Farber Cancer Institute; Data; Dental; Dental Care; Dental Hygiene; Dental caries; Dentists; Diagnosis; Disease; Effectiveness; Enrollment; Epidemiologist; Expert Opinion; Exposure to; Eye; Fluorides; Foundations; Fred Hutchinson Cancer Research Center; Funding; Future; Generations; Goals; Guidelines; Health; Health Services Accessibility; Health Status; Immune; Individual; Instruction; Intervention; Knowledge; Lesion; Level of Evidence; Lichen Planus; Liver; Lung; Malignant Neoplasms; Measures; Mediating; Mucous Membrane; Oncology; Oral; Oral Examination; Oral cavity; Oral health; Organ; Outcome; Patient Outcomes Assessments; Patients; Personal Satisfaction; Pharmaceutical Preparations; Population; Prior Therapy; Prospective Studies; Prospective cohort; Protocols documentation; Quality of life; Recording of previous events; Research Personnel; Resources; Retrospective cohort; Risk; Risk Factors; Salivary; Site; Skin; Supplementation; System; Testing; Tooth Loss; Transplant Recipients; Transplantation; Treatment Effectiveness; Treatment outcome; Trismus; United States National Institutes of Health; Universities; Visit; Vulnerable Populations; Washington; Xerostomia; chronic graft versus host disease; cohort; comparison control; cost; data repository; demographics; design; evidence base; experience; health related quality of life; hematopoietic cell transplantation; improved; mouth squamous cell carcinoma; oral care; personalized management; population based; protective factors; recruit; secondary analysis; secondary endpoint; tool

Abstract: Nearly 50% of allogeneic hematopoietic cell transplantation recipients (AlloHCT) will develop chronic graft- versus-host disease (cGVHD). Oral involvement is seen in approximately 80% of patients with cGVHD. It presents as mucosal lesions mimicking lichen planus, hyposalivation, and trismus. Low-level evidence suggests that oral cGVHD is associated with increased risk for dental, periodontal, and mucosal diseases. The current oral health guidelines for cGVHD are largely based on expert opinion. Little evidence exists to guide treatment decisions or to personalize management plans. The short-term objective of this application is to address the important gaps of knowledge described above and generate a rationale for establishing an evidence-based approach in the management of patients with oral cGVHD. Our hypothesis is that exposure to oral cGVHD leads to increased tooth loss and that recalcitrant oral cGVHD decreases oral-health-related quality of life (OHRQL) (secondary endpoint), an effect which we hypothesize is mediated by mucosal sensitivity, reduced salivary flow, and trismus. We will utilize the on-going collaboration between the Fred Hutchinson Cancer Research Center (FHCRC) and the Dana-Farber Cancer Institute (DFCI), two key sites of the NIH-funded cGVHD Consortium and nest our studies in a large established population-based cohort. First, we will determine tooth loss rates and OHRQL in AlloHCT recipients and explore their association with oral cGVHD. Subjects in an established and representative cohort of the Chronic GVHD Consortium will be recruited in a retrospective cohort. They will undergo an oral examination by a calibrated examiner. Tooth loss will be evaluated by comparing current status to data collected at the pre-AlloHCT oral examination. OHRQL will be measured through a validated tool (OHIP14). Current and past oral cGVHD status (per NIH criteria) will be assessed through mucosal examination and through Consortium data. We will test for associations between exposure to cGVHD (number of visits with oral cGVHD), tooth loss, and OHRQL. Secondary analysis will assess other risk factors associated with tooth loss and lower OHRQL. Second, we will evaluate the association between recalcitrant oral cGVHD and OHRQL. Subjects with past (exposed) and current oral cGVHD will be enrolled in a prospective cohort and re-evaluated twice per year as in Aim#1. They will receive a comprehensive oral examination including mucosal and periodontal health, caries, and tooth loss. Patient reported outcomes will be measured with validated tools. Additionally, information will be collected from each subjects' primary dentist including number of visits, dental procedures, oral hygiene instructions, fluoride supplementation, and use of sialogogues/ salivary substitutes. We will explore associations between OHRQL and cGVHD, expecting the presence and intensity of oral cGVHD to be associated with lower OHRQL. Secondary analysis will assess additional mediating factors.

抽象的： 近50％的同种异体造血细胞移植受者（AllOHCT）将发展慢性移植 与宿主病（CGVHD）。在大约80％的CGVHD患者中，口腔受累。它 粘膜病变的粘膜病变，模仿地衣平面，脱落和三症。低级证据表明 该口服CGVHD与牙齿，牙周和粘膜疾病的风险增加有关。电流 CGVHD的口腔健康指南主要基于专家意见。几乎没有证据来指导治疗 决策或个性化管理计划。 该应用程序的短期目标是解决上述知识的重要差距 并产生一个理由来建立口服患者管理中的基于证据的方法 CGVHD。我们的假设是，暴露于口服CGVHD会导致牙齿脱落增加，并且口服顽固性 CGVHD降低了与口腔健康相关的生活质量（OHRQL）（次要终点），这是我们的效果 假设是由粘膜敏感性，唾液流量降低和三体介导的。我们将利用正在进行的 弗雷德·哈钦森癌症研究中心（FHCRC）与达纳 - 法伯癌之间的合作 Institute（DFCI），NIH资助的CGVHD联盟的两个关键地点，并将我们的研究嵌套 建立的基于人群的队列。 首先，我们将在AllOHCT接受者中确定牙齿损失率和OHRQL，并探索他们与 口服CGVHD。慢性GVHD联盟已建立且代表性的队列中的受试者将是 在回顾人群中招募。他们将通过校准的检查员进行口腔检查。牙齿脱落 将通过将当前状态与在AlloHCT前口腔检查中收集的数据进行比较来评估。 ohrql 将通过经过验证的工具（OHIP14）进行测量。当前和过去的口服CGVHD状态（根据NIH标准） 将通过粘膜检查和财团数据评估。我们将测试关联 在接触CGVHD（口服CGVHD的访问次数）之间，牙齿脱落和OHRQL之间。次要分析 将评估与牙齿脱落和较低OHRQL相关的其他危险因素。 其次，我们将评估顽固的口服CGVHD和OHRQL之间的关联。有过去的主题 （暴露）和当前的口服CGVHD将在预期队列中注册，并每年重新评估两次 目标＃1。他们将接受全面的口试检查，包括粘膜和牙周健康，龋齿， 和牙齿脱落。患者报告的结果将通过经过验证的工具来衡量。此外，信息还将 从每个受试者的主要牙医中收集，包括访问次数，牙科手术，口腔卫生 指示，补充氟化物和唾液/唾液替代品的使用。我们将探索 OHRQL和CGVHD之间的关联，期望口服CGVHD的存在和强度是 与较低的OHRQL相关。次要分析将评估其他中介因子。

项目成果

A Review of Oral Chronic Graft-Versus-Host Disease: Considerations for dental hygiene practice.

口腔慢性移植物抗宿主病综述：牙齿卫生实践的注意事项。

• 发表时间: 2022
• 期刊: Journal of dental hygiene : JDH
• 作者: Johnson,LisaBennett;Oh,Uhlee;Rothen,Marilynn;Sroussi,HerveY;Dean,DavidR;Lloid,CMichele;Cintron,Katelyn;Lee,StephanieJ;Cutler,CoreyS;Treister,NathanielS
• 通讯作者: Treister,NathanielS