Mucosal Chronic GVHD Affecting the Oral Pharyngeal, Esophageal, and Anogenital Regions

Chronic GVHD (cGVHD) targets several regions not affected by acute GVHD (aGVHD), including the oropharynx, the upper portion of the esophagus, and the anogenital region. These regions are surfaced by nonkeratinized squamous mucosa and have similar histology: chronic lymphocytic inflammation with variable apoptosis of the surface. The changes in underlying or adjacent tissues vary by the location resulting in different complications. Oral GVHD results in cheilitis, gum recession, dental decay, and lichen planus-like like streaks on the buccal mucosa, usually accompanied by sicca (see Chap. 17). Esophageal chronic GVHD (cGVHD) frequently presents in patients who have oropharyngeal GVHD and generalized cGVHD. The symptoms are dysphagia and odynophagia. Endoscopy reveals a desquamative sloughing of the mucosa in the upper-to-middle third of the esophagus with formation of synechiae or fibrotic webs. Anogenital involvement of the perianal region, vulva/vagina, and penis leads to lichen sclerosis et atrophicus-like changes with atrophy and stenosis. The symptoms and differential diagnoses of cGVHD in these locations are discussed.