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Incidence and risk factors for oral mucositis in pediatric patients receiving chemotherapy

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Abstract

Purpose

To investigate the incidence and risk factors for oral mucositis (OM) in patients with childhood cancer undergoing chemotherapy.

Methods

Eight hundred and twenty-nine cycles of chemotherapy were evaluated in 112 patients with childhood cancer undergoing chemotherapy. Chemotherapy protocol, hematological, hepatic, and renal function parameters were collected and compared to presence and severity of OM, as graded by the World Health Organization (WHO) scale. Patients received counseling on oral hygiene and those who presented with OM (grade ≥1) received photobiomodulation therapy (PBMT).

Results

Age ranged from 0 to 17 years (mean/SD, 8.58 ± 5.05) and fifty-one patients (45.54%) were females. The most common baseline diseases were leukemia (51%) followed by sarcomas (23%) and lymphomas (18%). Eight hundred and twenty-nine cycles of chemotherapy were evaluated, and OM was diagnosed in 527 cycles (63.57%). Higher incidence and severity of OM was observed in protocols using high-dose methotrexate (MTX-HD), MTX-HD cyclophosphamide/doxorubicin combination, and MTX-HD combined with cyclophosphamide (p <0.001). Patients with severe OM had lower levels of leukocytes (p = 0.003), hemoglobin (p = 0.005), platelets (p = 0.034), and higher levels of total bilirubin (p = 0.027), alanine aminotransferase (ALT) (p = 0.001), and creatinine (p = 0.007).

Conclusion

The study contributes to the elucidation of the risk factors for OM in pediatric cancer patients. Chemotherapy protocols using MTX-HD, MTX-HD associated with doxorubicin and cyclophosphamide, and MTX-HD and cyclophosphamide a have higher incidence of severe grades of OM. Other toxicities such as hematological, hepatic, and renal also developed in patients with OM.

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Acknowledgments

The authors are grateful to all the members of the Pediatric Oncology Service of Porto Alegre Clinical Hospital (HCPA/UFRGS) for support during the development of the present research.

Availability of data and material

Authors have full control of all primary data and allow the journal to review the data.

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Not applicable

Funding

This study was supported by the PRONON/Ministry of Health, Brazil (grant no. 25000.056.976/2015-52); Postgraduate Research Group of Porto Alegre Clinics Hospital (GPPG/FIPE: 2016-0608), Brazilian National Council for Scientific and Technological Development (CNPq student scholarship), Children’s Cancer Institute (student scholarship), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES)- finance code 001. Rafael Roesler and Manoela Domingues Martins are research fellows funded by the Brazilian National Council for Scientific and Technological Development (CNPq).

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Author notes

  1. Marina Curra and Amanda F. Gabriel contributed equally to this work.

Authors and Affiliations

  1. Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, sala 503, CEP: 90035-003 Santana, Porto Alegre, RS, Brazil

    Marina Curra, Amanda F. Gabriel, Marco Antonio T. Martins & Manoela Domingues Martins

  2. Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil

    Maria Beatriz C. Ferreira

  3. Department of Oral Medicine, Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil

    Marco Antonio T. Martins & Manoela Domingues Martins

  4. Childhood Cancer Institute, Porto Alegre, RS, Brazil

    André T. Brunetto

  5. Department of Pediatric Oncology, Porto Alegre Clínicas Hospital (HCPA/UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil

    Lauro J. Gregianin

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  1. Marina Curra
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Contributions

Marina Curra: conceptualization; data curation; formal analysis; investigation; writing—original draft; writing—review and editing. Amanda F. Gabriel: conceptualization; data curation; formal analysis; investigation; writing—original draft; writing—review and editing. Maria Beatriz C. Ferreira: conceptualization; writing—review and editing. Marco Antonio T. Martins: conceptualization; data curation; writing—original draft; writing—review and editing. André T. Brunetto: conceptualization; data curation; formal analysis; writing—review and editing. Lauro J. Gregianin: conceptualization; data curation; formal analysis; writing—review and editing. Manoela D. Martins: conceptualization; data curation; formal analysis; investigation; methodology; project administration; writing original draft; writing—review and editing.

Corresponding author

Correspondence to Manoela Domingues Martins.

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Institutional Human Research Ethics Committee (HCPA protocol 14-0581 and CAEE 40921215.6.0000.5327).

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Curra, M., Gabriel, A.F., Ferreira, M.B.C. et al. Incidence and risk factors for oral mucositis in pediatric patients receiving chemotherapy. Support Care Cancer 29, 6243–6251 (2021). https://doi.org/10.1007/s00520-021-06199-5

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