The Impact of Oral Chronic Graft-Versus-Host Disease on Global Measures of Quality of Life

Chronic GVHD (cGVHD) is a frequent complication of allogeneic hematopoietic stem cell transplantation (HSCT) and affects multiple organ systems, with the oral cavity being one of the most frequently affected sites.  Patients with cGVHD experience reduced quality of life (QOL), yet the specific impact of oral cGVHD on QOL is poorly understood.  The objective of this study was to characterize the impact of oral cGVHD on global measures of QOL.  METHODS:  QOL data were collected using the FACT-BMT and SF-36 instruments for 569 patients enrolled in the Chronic GVHD Consortium, with a total of 1,915 follow-up visits.  At study enrollment, patients were categorized as isolated oral cGVHD (n=22), oral and concomitant extra-oral cGVHD (n=420), and only extra-oral cGVHD (n=127).  Utilizing all longitudinal data, QOL scores were compared using a multivariable linear model controlling for demographic, transplant, and cGVHD characteristics.  RESULTS:  Patients with isolated oral cGVHD reported better physical well-being (P=0.009), BMT well-being (P=0.01), and decreased bodily pain (P=0.01) compared to patients with oral and concomitant extra-oral cGVHD.  A similar trend was observed that patients with isolated oral cGVHD reported better physical well-being (P=0.02) and less bodily pain (P=0.02) compared to patients with only extra-oral cGVHD.  QOL scores were similar in several domains, most notably social/family well-being, physical role functioning, and vitality, when comparing patients with isolated oral cGVHD to patients with oral and concomitant extra-oral cGVHD and only extra-oral cGVHD.  CONCLUSIONS:  Isolated oral cGVHD is associated with better QOL compared to extra-oral cGVHD across multiple domains, in particular physical well-being and bodily pain.         Multivariable analysis comparing quality of life scores

		Isolated oral vs. oral and extra-oral		Isolated oral vs. only extra-oral
		difference in QOL scores between groups	p-value	difference in QOL scores between groups	p-value
FACT-BMT
	total	3.14	0.03	1.58	0.32
	physical well-being	1.09	0.009	1.09	0.02
	social/family well-being	0.17	0.63	-0.13	0.75
	emotional well-being	0.45	0.14	0.07	0.85
	functional well-being	0.88	0.05	0.29	0.56
	BMT well-being	1.10	0.01	0.81	0.10
SF-36
	PCS	1.20	0.14	1.08	0.23
	MCS	0.17	0.85	-0.67	0.50
	physical functioning	0.96	0.25	0.79	0.39
	physical role functioning	-0.29	0.76	-0.52	0.62
	bodily pain	2.26	0.01	2.43	0.02
	general health perceptions	1.62	0.05	0.22	0.81
	vitality	0.07	0.94	-0.50	0.60
	social role functioning	1.29	0.21	0.81	0.47
	emotional role functioning	0.46	0.67	-0.72	0.54
	mental health	0.27	0.75	-0.43	0.64

BMT= bone marrow transplant.  PCS= physical component score.  MCS= mental component score.