Previously, patient underwent a matched allogeneic BMT and donor nonstimulated leukocyte infusion (DLI), which were complicated by grade 3 mucositis and graft-versus-host disease (GVHD) of the mouth, respectively. Mouth and skin changes due to GVHD continued despite immunosuppressive therapy.
	Six years after DLI, the patient complained of worsening mouth discomfort and an inability to eat solid foods, which led to a 15-pound weight loss. His pain was a 6 on a 10-point scale, on which 1 indicated minimal pain and 10 indicated the worst pain.
	Oral examination revealed mucosal inflammation and several ulcerations.

Clinical Plan                                                                            

	Treatment included a mouth rinse containing an antacid, lidocaine, and diphenhydramine for local pain relief as needed.
	Immunosuppressive medications were adjusted.

Outcomes                                                                               

1 month later

Patient reported increasing pain, additional weight loss, burning with the oral mouthwash, and no improvement in his ulcerations.

Clinical Plan                                                                            

Treatment plan replaced the mouthwash with GELCLAIR (bioadherent oral gel) 4 times daily.

Outcomes                                                                               

1 month later

	Patient reported reduced pain (1-2 on 10-point scale), the ability to eat most solid foods, except hot or spicy foods, and a 6-pound weight gain.
	Examination showed significant improvement of the mucosal inflammation and full resolution of the ulcerations.
	The patient continues to use GELCLAIR on an occasional basis.