1. ¹Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
2. ²Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
3. ³Imperial College London, London, UK
4. ⁴Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
5. ⁵Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine and Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA

Correspondence: Dr H Mawardi, Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: hmawardi@partners.org

Received 16 June 2009; Revised 12 August 2009; Accepted 18 August 2009; Published online 2 November 2009.

Abstract

Chronic GVHD (cGVHD) frequently affects the oral cavity. The purpose of this study was to estimate the efficacy of combined topical dexamethasone (DEX) and tacrolimus (TAC) solutions in the management of oral cGVHD. The records of 14 patients with oral cGVHD treated with combined topical DEX/TAC were reviewed retrospectively. Pre-to-post treatment changes in subjective and objective measures were evaluated at a median follow-up of 60 days. Serum TAC levels were examined. Marginal objective improvement was detected at follow-up. The median pre-to-post treatment differences were 0.5 (range, -1 to 1) for erythema score, and 0.5 (range, 0 to 2) for lichenoid score, (P=0.06, 0.07 and 0.02, respectively). Subjective improvement was noted in three of four measures at the follow-up visit. The median differences in pain, sensitivity and dryness scores were 1 (range -1 to 6), 1 (range -3 to 5) and 2.5 (range, -5 to 5), respectively (0–10 scale, P<0.05). Four patients (37%) showed increased serum TAC levels; however, all remained within therapeutic range. In conclusion, combined topical DEX/TAC therapy appears to be effective in reducing symptoms attributable to oral cGVHD. Our data has shown minimal evidence of systemic TAC absorption.