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KMID : 0869620120290010017
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Journal of Korean Society of Hospital Pharmacists
2012 Volume.29 No. 1 p.17 ~ p.24
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Case Report on the Use of Cyclosporine solution for the treatment of Oral Graft versus host disease (GVHD) after BMT
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Lee Sul-Gi
Park Soo-Jin
Yeo Mi-Jin
Park Ae-Ryoung
Kim Soon-Joo
La Hyen-O
Kim Hee-Je
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Abstract
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Graft versus host disease (GVHD) is an important cause of morbidity and mortality in
hematopoietic stem cell transplantation patients. Patients with oral GVHD may develop symptomatic severe oral ulceration, erythema, lichenoid and lupus-like changes, in addition to the dryness of the oral mucosa, due to involvement of the salivary glands. A combined use of cyclosporine or tacrolimus and methotrexate is a principal approach for prevention of GVHD.
Corticosteroid is used as the first-line therapy, but clinical effects of the other treatments have not been proven yet. Moreover, there are possibilities of the adverse effects induced from systemic use of corticosteroids and immunosuppressive agents, thus, the need of adjuvant local therapies emerged. In this case report, we described the management of oral GVHD with topical cyclosporine solution.
A 53-year-old female, diagnosed as Acute myeloid leukemia (AML), received an allogenic
hematopoietic stem cell transplantation (HSCT) and developed GVHD, involving skin, gut and oral cavity. Management included systemic corticosteroids and topical agents, such as normal saline and chlorhexidine, to relieve oral symptoms. However, it did not show a significant improvement.
The patient was readmitted for GVHD and cytomegalovirus retinitis after being discharged. At this point, oral GVHD was estimated as a total score of 10, the sum of erythema 3, linchenoid 1, ulceration 6 and mucoceles 0, by the National Institutes of Health (NIH) consensus scoring system with numerical rating scale (NRS) of 10 for pain. The patient was decided to use cyclosporine solution as an oral rinse in the condition of oral intake restriction due to bleeding tendency. We opted for the patient to use the cyclosporine solution. Oncology pharmacist instructed the patient to rinse the mouth with 5ml of cyclosporine solution for 5 minutes, three times a day. After two weeks, the application of cyclosporine mouth rinse resulted in an improvement of the oral GVHD; total score of 4 presented, as the sum of erythema 1, linchenoid 0, ulceration 3 and mucoceles 0, with NRS 4 in the pain.
Application of cyclosporine mouth rinse is considered to be a remedy for oral GVHD to minimize the adverse effects induced from systemic therapy and to maximize curative value.
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KEYWORD
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oral Graft versus host disease (GVHD), cyclosporine solution, mouth rinse
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