Supportive Care in Cancer

, Volume 22, Issue 1, pp 15–21 | Cite as

Oral status of patients submitted to autologous hematopoietic stem cell transplantation

  • Liana Leite Duval Fernandes
  • Sandra R. Torres
  • Marcia Garnica
  • Lucio de Souza Gonçalves
  • Arley Silva Junior
  • Álvaro Copello de Vasconcellos
  • Wellington Cavalcanti
  • Angelo Maiolino
  • Maria Cynésia Medeiros de Barros Torres
Original Article

Abstract

Purpose

Oral infection may be a source of bacteremia in patients undergoing hematopoietic stem cell transplant (HSCT). The aim of this study was to evaluate the relationship between patients with poor periodontal status and complications after HSCT.

Methods

A cohort of patients with hematological malignancies candidates for autologous HSCT was observed before and during the neutropenic phase of HSCT. A primary evaluation was performed before the HSCT procedure, including medical and socio-demographic data and physical examination (number of teeth and decayed, missing and filled teeth index (DMFT), oral mucosa, and full mouth periodontal assessment). During the neutropenic phase, data regarding the development of febrile neutropenia, bacteremia, and mucositis were also prospectively obtained.

Results

Forty-eight patients were included. The most common baseline disease was multiple myeloma (70 %). In the primary evaluations, the median DMFT was 13 (ranging 0–27), and periodontitis and gingivitis were present in 29 and 60 % of the patients, respectively. During the neutropenic phase of HSCT, fever occurred in 96 % of patients, and bacteremia was documented in 29 %. Coagulase-negative Staphylococcus was the most common isolated bacteria. Patients who developed bacteremia had a higher frequency of oral disorders compared with those without bacteremia, but it was not statistically significant. Oral mucositis affected 89.6 % of the patients, and patients with gingivitis or periodontal disorders had a high frequency of mucositis.

Conclusions

The prevalence of oral pathologic conditions previous to HSCT procedures was very high in the studied population. A possible association was noted between previous gingivitis and the development of mucositis during the neutropenia of HSCT.

Keywords

Hematopoietic stem cell transplantation Periodontal diseases Oral mucositis Gingivitis Bacteremia 

Notes

Acknowledgments

This work was supported by FAPERJ (Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro) and CNPq (Conselho Nacional do Desenvolvimento Cientifico e Tecnológico).

Conflict of interest

The authors declare no conflict of interest.

References

  1. 1.
    Mullen CA, Nair J, Sandesh S, Chan KW (2000) Fever and neutropenia in pediatric hematopoietic stem cell transplant patients. Bone Marrow Transplant 25:59–65PubMedCrossRefGoogle Scholar
  2. 2.
    Epstein JB, Raber-Durlacher JE, Wilkins A, Chavarria MG, Myint H (2009) Advances in hematologic stem cell transplant: an update for oral health care providers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:301–312PubMedCrossRefGoogle Scholar
  3. 3.
    Pattni R, Walsh LJ, Marshall RI, Cullinan MP, Seymour GJ, Bartold PM (2000) Changes in the periodontal status of patients undergoing bone marrow transplantation. J Periodontol 71:394–402PubMedCrossRefGoogle Scholar
  4. 4.
    Akintoye SO, Brennan MT, Graber CJ, McKinney BE, Rams TE, Barrett AJ, Atkinson JC (2002) A retrospective investigation of advanced periodontal disease as a risk factor for septicemia in hematopoietic stem cell and bone marrow transplant recipients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:581–588PubMedCrossRefGoogle Scholar
  5. 5.
    Goldman KE (2006) Dental management of patients with bone marrow and solid organ transplantation. Dent Clin North Am 50:659–676, viiiGoogle Scholar
  6. 6.
    Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, Migliorati CA, McGuire DB, Hutchins RD, Peterson DE (2007) Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109:820–831PubMedCrossRefGoogle Scholar
  7. 7.
    Soga Y, Yamasuji Y, Kudo C, Matsuura-Yoshimoto K, Yamabe K, Sugiura Y, Maeda Y, Ishimaru F, Tanimoto M, Nishimura F, Takashiba S (2009) Febrile neutropenia and periodontitis: lessons from a case periodontal treatment in the intervals between chemotherapy cycles for leukemia reduced febrile neutropenia. Support Care Cancer 17:581–587PubMedCrossRefGoogle Scholar
  8. 8.
    Frere P, Hermanne JP, Debouge MH, de Mol P, Fillet G, Beguin Y (2004) Bacteremia after hematopoietic stem cell transplantation: incidence and predictive value of surveillance cultures. Bone Marrow Transplant 33:745–749PubMedCrossRefGoogle Scholar
  9. 9.
    Borowski B, Benhamou E, Pico JL, Laplanche A, Margainaud JP, Hayat M (1994) Prevention of oral mucositis in patients treated with high-dose chemotherapy and bone marrow transplantation: a randomised controlled trial comparing two protocols of dental care. Eur J Cancer B Oral Oncol 30B:93–97PubMedCrossRefGoogle Scholar
  10. 10.
    Donker AE, van Merkesteyn JP, Bredius RG, van Weel-Sipman MH (2002) Value of panoramic radiographs in paediatric pre-bone marrow transplantation oral evaluation. Int J Oral Maxillofac Surg 31:170–172PubMedCrossRefGoogle Scholar
  11. 11.
    Yamagata K, Onizawa K, Yanagawa T, Hasegawa Y, Kojima H, Nagasawa T, Yoshida H (2006) A prospective study to evaluate a new dental management protocol before hematopoietic stem cell transplantation. Bone Marrow Transplant 38:237–242PubMedCrossRefGoogle Scholar
  12. 12.
    Djuric M, Hillier-Kolarov V, Belic A, Jankovic L (2006) Mucositis prevention by improved dental care in acute leukemia patients. Support Care Cancer 14:137–146PubMedCrossRefGoogle Scholar
  13. 13.
    Soga Y, Saito T, Nishimura F, Ishimaru F, Mineshiba J, Mineshiba F, Takaya H, Sato H, Kudo C, Kokeguchi S, Fujii N, Tanimoto M, Takashiba S (2008) Appearance of multidrug-resistant opportunistic bacteria on the gingiva during leukemia treatment. J Periodontol 79:181–186PubMedCrossRefGoogle Scholar
  14. 14.
    Chen CY, Hansen KS, Hansen LK (2008) Rhizobium radiobacter as an opportunistic pathogen in central venous catheter-associated bloodstream infection: case report and review. J Hosp Infect 68:203–207PubMedCrossRefGoogle Scholar
  15. 15.
    Pion FLB, Araújo MWB, Feres M, Cortelli SC (2006) Periodontal status of a population subgroup from Guarulhos, SP. Revista Brasileira de Epidemiologia 9:335–345CrossRefGoogle Scholar
  16. 16.
    Schaira V, Boer C, Basso F, Kellermann M, Correa ME (2009) Oral healthy characteristics and dental management of hematopoetic stem cell transplantation patients in a single public hospital. In Multinational Association for Supportive Care in Cancer (MASCC), pp. 164Google Scholar
  17. 17.
    Schubert MM, Williams BE, Lloid ME, Donaldson G, Chapko MK (1992) Clinical assessment scale for the rating of oral mucosal changes associated with bone marrow transplantation. Development of an oral mucositis index. Cancer 69:2469–2477PubMedCrossRefGoogle Scholar
  18. 18.
    Oliveira AL, de Souza M, Carvalho-Dias VM, Ruiz MA, Silla L, Tanaka PY, Simoes BP, Trabasso P, Seber A, Lotfi CJ, Zanichelli MA, Araujo VR, Godoy C, Maiolino A, Urakawa P, Cunha CA, de Souza CA, Pasquini R, Nucci M (2007) Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients. Bone Marrow Transplant 39:775–781PubMedCrossRefGoogle Scholar
  19. 19.
    HIS— Immunocompromised Host Society (1990) The design, analysis, and reporting of clinical trials on the empirical antibiotic management of the neutropenic patient. Report of a consensus panel J Infect Dis 161:397–401Google Scholar
  20. 20.
    NIH— National Institute of Health (1990) Consensus Development Panel. Consensus statement: oral complications of cancer therapies: diagnosis, prevention and treatment. NCI Monogr 9Google Scholar
  21. 21.
    Ellegard B, Bergmann OJ, Ellegaard J (1989) Effect of plaque removal on patients with acute leukemia. J Oral Pathol Med 18:54–58CrossRefGoogle Scholar
  22. 22.
    Graber CJ, de Almeida KN, Atkinson JC, Javaheri D, Fukuda CD, Gill VJ, Barrett AJ, Bennett JE (2001) Dental health and viridans streptococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant 27:537–542PubMedCrossRefGoogle Scholar
  23. 23.
    Elad S, Garfunkel AA, Or R, Michaeli E, Shapira MY, Galili D (2003) Time limitations and the challenge of providing infection-preventing dental care to hematopoietic stem-cell transplantation patients. Support Care Cancer 11:674–677PubMedCrossRefGoogle Scholar
  24. 24.
    Barker GJ (1999) Current practices in the oral management of the patient undergoing chemotherapy or bone marrow transplantation. Support Care Cancer 7:17–20PubMedCrossRefGoogle Scholar
  25. 25.
    Barasch A (2000) Coke JM (2007) Cancer therapeutics: an update on its effects on oral health. Periodontol 44:44–54CrossRefGoogle Scholar
  26. 26.
    Blade J, Rosinol L (2009) Changing paradigms in the treatment of multiple myeloma. Haematologica 94:163–166PubMedCrossRefGoogle Scholar
  27. 27.
    Wingard JR (2002) Antifungal chemoprophylaxis after blood and marrow transplantation. Clin Infect Dis 34:1386–1390PubMedCrossRefGoogle Scholar
  28. 28.
    Heimdahl A, Mattsson T, Dahllof G, Lonnquist B, Ringden O (1989) The oral cavity as a port of entry for early infections in patients treated with bone marrow transplantation. Oral Surg Oral Med Oral Pathol 68:711–716PubMedCrossRefGoogle Scholar
  29. 29.
    Epstein JB, Chow AW (1999) Oral complications associated with immunosuppression and cancer therapies. Infect Dis Clin North Am 13:901–923PubMedCrossRefGoogle Scholar
  30. 30.
    Davies AN, Brailsford SR, Beighton D, Shorthose K, Stevens VC (2008) Oral candidosis in community-based patients with advanced cancer. J Pain Symptom Manage 35:508–514PubMedCrossRefGoogle Scholar
  31. 31.
    Pentenero M, Broccoletti R, Carbone M, Conrotto D, Gandolfo S (2008) The prevalence of oral mucosal lesions in adults from the Turin area. Oral Dis 14:356–366PubMedCrossRefGoogle Scholar
  32. 32.
    Santos PSS, Magalhães MHSG (2006) Oral mucositis evaluation in patients exposed to oral care procedures before bone marrow transplantation. RPG Rev Pos Grad 13:77–82Google Scholar
  33. 33.
    Melkos AB, Massenkeil G, Arnold R, Reichart PA (2003) Dental treatment prior to stem cell transplantation and its influence on the posttransplantation outcome. Clin Oral Investig 7:113–115PubMedCrossRefGoogle Scholar
  34. 34.
    Rubenstein EB, Peterson DE, Schubert M, Keefe D, McGuire D, Epstein J, Elting LS, Fox PC, Cooksley C, Sonis ST (2004) Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 100:2026–2046PubMedCrossRefGoogle Scholar
  35. 35.
    Reich G, Mapara MY, Reichardt P, Dorken B, Maschmeyer G (2001) Infectious complications after high-dose chemotherapy and autologous stem cell transplantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors. Bone Marrow Transplant 27:525–529PubMedCrossRefGoogle Scholar
  36. 36.
    Auner HW, Sill H, Mulabecirovic A, Linkesch W, Krause R (2002) Infectious complications after autologous hematopoietic stem cell transplantation: comparison of patients with acute myeloid leukemia, malignant lymphoma, and multiple myeloma. Ann Hematol 81:374–377PubMedCrossRefGoogle Scholar
  37. 37.
    Weikel DS, Peterson DE, Rubinstein LE, Metzger-Samuels C, Overholser CD Jr (1989) Incidence of fever following invasive oral interventions in the myelosuppressed cancer patient. Cancer Nurs 12:265–270PubMedCrossRefGoogle Scholar
  38. 38.
    Salazar R, Sola C, Maroto P, Tabernero JM, Brunet J, Verger G, Valenti V, Cancelas JA, Ojeda B, Mendoza L, Rodriguez M, Montesinos J, Lopez-Lopez JJ (1999) Infectious complications in 126 patients treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 23:27–33PubMedCrossRefGoogle Scholar
  39. 39.
    Collin BA, Leather HL, Wingard JR, Ramphal R (2001) Evolution, incidence, and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients. Clin Infect Dis 33:947–953PubMedCrossRefGoogle Scholar
  40. 40.
    Nucci M, Andrade F, Vigorito A, Trabasso P, Aranha JF, Maiolino A, De Souza CA (2003) Infectious complications in patients randomized to receive allogeneic bone marrow or peripheral blood transplantation. Transpl Infect Dis 5:167–173PubMedCrossRefGoogle Scholar
  41. 41.
    Johnson GK, Slach NA (2001) Impact of tobacco use on periodontal status. Journal of Dental Education 65:313–321PubMedGoogle Scholar
  42. 42.
    Castillo JJ, Dhami PK, Curry S, Brennan K (2012) No association between cigarette smoking and incidence of plasma cell myeloma: a meta-analysis of 17 observational studies. American Journal of Hematology 87:729–731PubMedCrossRefGoogle Scholar
  43. 43.
    Bucaneve G, Micozzi A, Menichetti F, Martino P, Dionisi MS, Martinelli G, Allione B, D'Antonio D, Buelli M, Nosari AM, Cilloni D, Zuffa E, Cantaffa R, Specchia G, Amadori S, Fabbiano F, Deliliers GL, Lauria F, Foa R, Del Favero A (2005) Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. The New England Journal of Medicine 353:977–987PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Liana Leite Duval Fernandes
    • 1
    • 2
  • Sandra R. Torres
    • 3
    • 4
  • Marcia Garnica
    • 5
  • Lucio de Souza Gonçalves
    • 4
  • Arley Silva Junior
    • 3
    • 4
  • Álvaro Copello de Vasconcellos
    • 5
  • Wellington Cavalcanti
    • 6
  • Angelo Maiolino
    • 5
  • Maria Cynésia Medeiros de Barros Torres
    • 7
  1. 1.Universidade Federal do Rio de JaneiroRio de JaneiroBrazil
  2. 2.São PauloBrazil
  3. 3.Department of Oral Pathology and Diagnosis, School of DentistryUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
  4. 4.Oral Health Program, Clementino Fraga Filho HospitalUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
  5. 5.Hematology Service, Hospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
  6. 6.Dental DepartmentInstituto de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO)Rio de JaneiroBrazil
  7. 7.Departmentof Dental Clinic, School of DentistryUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil

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