A primary analysis of oral mucosa and periodontal status of chronic graft-versus-host disease caused by hematopoietic stem cell transplantation

doi:10.19439/j.sjos.2018.06.011

Abstract

Abstract: PURPOSE: The aim of this study was to investigate the severity and status of oral mucosa and periodontal status in early and late stage after receiving hematopoietic stem cell transplantation(HSCT). METHODS: This study enrolled patients submitted to hematopoietic stem cell transplantation. Through a survey questionnaire, clinical examination, we collected clinical data from 108 HSCT recipients and divided them into 2 groups: transplantation time less than 1 year and more than 1 year. The oral mucosal and periodontal status were recorded and statistically analyzed with SPSS 21.0 software package. RESULTS: The incidence of oral features after HSCT was 78.95%. The incidence of mild symptoms with HSCT less than 1year (n=32) and HSCT more than 1 year (n=43) was 59.38% and 18.60%, respectively. There was significant difference between the two groups (χ²=11.525, P=0.001).The percent of lichenoid/hyperkeratotic plaques was 31.25% and 60.47%, respectively. The lichenoid/hyperkeratotic plaques were significantly different between the two groups (χ²=6.274, P=0.012). The detection rate of shallow and moderate pockets was 49.38% and 40.74%, respectively. Visual plaque, calculus and bleeding on probing were 62.96%, 64.20% and 50.62%, respectively. CONCLUSIONS: The incidence of periodontal and mucosal lesions after HSCT is high. The mild symptoms of oral graft versus host disease in early stage are identified obviously, mainly like lichenoid/hyperkeratotic plaques in late stage.

Key words: Hematopoietic stem cell transplantation, Oral chronic graft-versus-host Disease, Oral mucosa, Periodontal status

CLC Number:

R781.5

LV Ke-jia, YAN Duo-duo, WANG Guo-hua, YAO Ya-nan, YAO Hua. A primary analysis of oral mucosa and periodontal status of chronic graft-versus-host disease caused by hematopoietic stem cell transplantation[J]. Shanghai Journal of Stomatology, 2018, 27(6): 617-623.

References

[1] Cho A, Just U, Knobler R.Cutaneous graft-versus-host disease[J]. Hautarzt, 2018, 69(2): 109-115.
[2] Gomes AO, Torres SR, Maiolino A, et al.Early and late oral features of chronic graft-versus-host disease[J]. Rev Bras Hematol Hemoter, 2014, 36(1): 43-49.
[3] Arora M, Klein JP, Weisdorf DJ, et al.Chronic GVHD risk score: a Center for International Blood and Marrow Transplant Research analysis[J]. Blood, 2011, 117(24): 6714-6720.
[4] Yuan A, Chai X, Martins F, et al.Oral chronic GVHD outcomes and resource utilization: a subanalysis from the chronic GVHD consortium[J]. Oral Dis, 2016, 22(3): 235-240.
[5] Santos PS, Cassia MF, Heliton SA, et al.Oral graft vs host disease: An immune system disorder in hematopoietic cell transplantation[J]. World J Stomatol, 2015, 4(2): 96-102.
[6] Imanguli MM, Alevizos I, Brown R, et al.Oral graft-versus-host disease[J]. Oral Dis, 2008, 14(5): 396-412.
[7] Montebugnoli L, Gissi DB, Marchetti C, et al.Multiple squamous cell carcinomas of the oral cavity in a young patient with graft-versus-host disease following allogenic bone marrow transplantation[J]. Int J Oral Maxillofac Surg, 2011, 40(5): 556-558.
[8] Woo SB, Sonis ST, Monopoli MM, et al.A longitudinal study of oral ulcerative mucositis in bone marrow transplant recipients[J]. Cancer, 1993, 72(5): 1612-1617.
[9] Lim Z, Brand R, Martino R, et al.Allogeneic hematopoietic stem-cell transplantation for patients 50 years or older with myelodysplastic syndromes or secondary acute myeloid leukemia[J]. J Clin Oncol, 2010, 28(3): 405-411.
[10] Gupta V, Tallman MS, Weisdorf DJ.Allogeneic hematopoietic cell transplantation for adults with acute myeloid leukemia: myths, controversies, and unknowns[J]. Blood, 2011, 117(8): 2307-2318.
[11] Parovichnikova EN, Kuzmina LA, Mendeleeva LP, et al.Autologous hematopoietic stem cell transplantation as late high-dose consolidation in adult patients with T-cell lymphoblastic leukemias: Results of a Russian multicenter study[J]. Ter Arkh, 2015, 87(7): 15-25.
[12] 邹外一. 非血缘造血干细胞移植的现状与挑战[J]. 实用医学杂志, 2016, 32(1): 11-13.
[13] Filipovich AH, Weisdorf D, Pavletic S, et al.National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report[J]. Biol Blood Marrow Transplant, 2005, 11(12): 945-956.
[14] Fernandes LL, Torres SR, Garnica M, et al.Oral status of patients submitted to autologous hematopoietic stem cell transplantation[J]. Support Care Cancer, 2014, 22(1): 15-21.
[15] Chu Y, Ouyang X.Accuracy of partial-mouth examination protocols for extent and severity estimates of periodontitis: a study in a Chinese population with chronic periodontitis[J]. J Periodontol, 2015, 86(3): 406-417.
[16] Tran DT, Gay I, Du XL, et al.Assessing periodontitis in populations: a systematic review of the validity of partial-mouth examination protocols[J]. J Clin Periodontol, 2013, 40(12): 1064-1071.
[17] Peres MA, Peres KG, Cascaes AM, et al.Validity of partial protocols to assess the prevalence of periodontal outcomes and associated sociodemographic and behavior factors in adolescents and young adults[J]. J Periodontol, 2012, 83(3): 369-378.
[18] Bassim CW, Fassil H, Mays JW, et al.Oral disease profiles in chronic graft versus host disease[J]. J Dent Res, 2015, 94(4): 547-554.
[19] Fassil H, Bassim CW, Mays J, et al.Oral chronic graft-vs.-host disease characterization using the NIH scale[J]. J Dent Res, 2012,91(7 Suppl): 45S-51S.
[20] Pavletic SZ, Martin P, Lee SJ, et al.Measuring therapeutic response in chronic graft-versus-host disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. Response Criteria Working Group report[J]. Biol Blood Marrow Transplant, 2006, 12(3): 252-266.
[21] Kusakabe M, Kurita N, Nishikii H, et al.Haploidentical transplantation using post-transplant high-dose cyclophosphamide for adult T-cell lymphoma after mogamulizumab treatment[J]. Rinsho Ketsueki, 2017, 58(5): 449-454.
[22] Su W, Thompson M, Sheu RD, et al.Low-dose cranial boost in high-risk adult acute lymphoblastic leukemia patients undergoing bone marrow transplant[J]. Pract Radiat Oncol, 2017, 7(2): 103-108.
[23] Miller AB, Hoogstraten B, Staquet M, et al.Reporting results of cancer treatment[J]. Cancer, 1981,47(1): 207-214.
[24] Mitchell SA, Jacobsohn D, Thormann Powers KE, et al.A multi-center pilot evaluation of the national institutes of health chronic graft-versus-host disease (cGVHD) therapeutic response measures: feasibility, interrater reliability, and minimum detectable change[J]. Biol Blood Marrow Transplant, 2011, 17(11): 1619-1629.
[25] DePalo J, Chai X, Lee SJ, et al. Assessing the relationship between oral chronic graft-versus-host disease and global measures of quality of life[J]. Oral Oncol, 2015, 51(10): 944-949.
[26] Wardley AM, Scarffe JH.Role of granulocyte-macrophage colony-stimulating factor in chemotherapy-induced oral mucositis[J]. J Clin Oncol, 1996, 14(5): 1741-1743.
[27] Silva GB, Mendonca EF, Bariani C, et al.The prevention of induced oral mucositis with low-level laser therapy in bone marrow transplantation patients: a randomized clinical trial[J]. Photomed Laser Surg, 2011, 29(1): 27-31.
[28] Silva LC, Sacono NT, Freire Mdo C, et al.The impact of low-level laser therapy on oral mucositis and quality of life in patients undergoing hematopoieticstem cell transplantation using the oral health impact profile and the functional assessment of cancer therapy-bone marrow transplantation questionnaires[J]. Photomed Laser Surg, 2015, 33(7): 357-363.
[29] Bezinelli LM, Eduardo FP, Neves VD, et al.Quality of life related to oral mucositis of patients undergoing haematopoietic stem cell transplantation and receiving specialised oral care with low-level laser therapy: a prospective observational study[J]. Eur J Cancer Care (Engl), 2016, 25(4): 668-674.
[30] Santos PS, Coracin FL, Barros JC, et al.Impact of oral care prior to HSCT on the severity and clinical outcomes of oral mucositis[J]. Clin Transplant, 2011, 25(2): 325-328.
[31] Kashiwazaki H, Matsushita T, Sugita J, et al.Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation[J]. Support Care Cancer, 2012, 20(2): 367-373.