Effect of oral chronic GvHD on bodyweight in adults

In patients that develop chronic graft-versus-host disease (cGvHD) following hematopoietic stem cell transplantation (HSCT), 45–83% experience oral involvement (oral cGvHD).¹ Patients with cGvHD may have a lower body mass index (BMI) and suffer from malnutrition; however, the association between oral cGvHD and bodyweight has not been assessed.¹

Here, we summarize key data from a retrospective study evaluating the effect of oral cGvHD on bodyweight published by Aboalela et al.¹ in PLOS ONE.

Study design¹

• This was a retrospective study of patients aged ≥ 16 years who received an allogeneic HSCT at a tertiary care hospital in Riyadh, Saudi Arabia between January 2015, and December 2020.
• Patients were divided into two cohorts based on whether they were diagnosed with cGvHD (oral or non-oral) or not after HSCT.
• BMI and weight were stratified and gathered as pre-and-posttransplant weight, mean weight after acquiring cGvHD for the first year, and post-cGvHD BMI.
• Patients were matched and compared with two age and gender matched non-GvHD controls at a 1:2 ratio.

Key findings¹

• In total, 137 patients aged 16–70 years old were enrolled in this study (oral cGvHD n = 42, non-oral cGvHD n = 12, and non-GvHD n = 83).
• BMI was calculated as the weight (kg) divided by the square of height (m) and catergorized into underweight (BMI <18.5 kg/m2) or normal/above normal weight (BMI >18.5 kg/m2).
• The prevalence (95% confidence interval [CI]) per 100 patients of being underweight was 38.1 (23.6–54.4) and 26.8 (17.4–37.3) in the oral cGvHD and the non-GvHD cohort, respectively.
• The incidence (95% CI) per 100 patients of being underweight was 28.6 (14.8–49.9) and 8.43 (3.4–17.4) in the oral cGvHD and the non-GvHD cohort, respectively.

• In the oral cGvHD cohort, patients showed a 1.44 times higher risk of being underweight compared with those in the non-GvHD cohort.
• Patients with oral cGvHD were significantly more likely to exhibit >5% weight loss than the non-GvHD cohort (Figure 1).
• Weight change analysis was calculated as the difference between weight at the clinical visit and weight pre-HSCT, divided by weight pre-HSCT.

• Among symptoms experienced by patients with oral cGvHD, oral mucositis was found to be an independent predictor of weight loss above 5% (p < 0.001).

GvHD, graft-versus-host disease; cGvHD, chronic GvHD; HSCT, hematopoietic stem cell transplantation.
*Adapted from Aboalela, et al.¹

Key learnings

Patients with oral cGvHD have an increased risk of being underweight compared with patients who do not develop GvHD post-HSCT. Patients with oral mucositis were more likely than those without to have >5% weight loss in the oral cGvHD cohort. Early and aggressive symptomatic oral treatment should be considered for patients who experience weight loss after HSCT.