Major salivary gland involvement in graft-versus-host disease: considerations related to pathogenesis, the role of cytokines and therapy.

Chronic graft-versus-host-disease (GVHD) is an autoimmune-like complication often occurring in patients who have been treated with bone marrow and peripheral blood stem cell transplantation. Various tissues and organs are damaged via the cytotoxicity rendered by the infiltrating donor graft T cells. The mucosal insult is enhanced by the reduced quantity and the altered quality of the saliva, since the salivary glands are a known major target of GVHD. The salivary changes are also expressed by a reduction in related functions, such as anti-infection activity, protection against mechanical and chemical epithelial injuries, assistance in controlling periodontal disease and caries, etc. The purpose of this review is to summarize the data that have been published recently concerning salivary involvement in GVHD and to suggest an underlying mechanism for the disease and its related 'state-of-the-art' therapeutic policy.