Advertisement

Oral and post-transplantation infectious status in patients with hematopoietic stem cell transplants: A prospective observational study

Published:October 13, 2022DOI:https://doi.org/10.1016/j.oooo.2022.10.002

      Objective

      Infectious status may be life threatening in hematopoietic stem cell transplant (HSCT) recipients. The aim of this study was to evaluate the effect of oral status on infectious conditions during the neutropenic phase after HSCT.

      Study Design

      Seventy patients with various hematologic malignancies were involved. Before HSCT, oral and periodontal examination, including the number of teeth and decayed, missing, and filled teeth index (DMFT); visible plaque (%); bleeding on probing (BOP [%]); clinical attachment level; and probing depth (PD) values were collected. Daily blood cultures were collected and analyzed in terms of infection-related parameters, including febrile neutropenia (FN), bacteremia, and C-reactive protein (CRP) during the neutropenic phase of HSCT.

      Results

      Forty-two patients (60%) received autologous and 28 (40%) allogeneic HSCT. In both groups, patients without FN after HSCT had significantly lower DMFT index scores and fewer sites with PD ≥4 mm (P < .05). However, bacteremia, FN, and CRP were similar in patients with periodontitis compared with non-periodontitis patients (P > .05).

      Conclusions

      The results suggest that periodontal status may not significantly impact the infection-related parameters in patients treated for HSCT. However, DMFT and the prevalence of sites with PD ≥4 mm may be involved in febrile neutropenia.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Tanyeli A
        • Aykut G
        • Demirel AO
        • Akçaoğlu T.
        Hematopoietic stem cell transplantation and history.
        Arşiv Kaynak Tarama Dergisi. 2014; 23 ([in Turkish]): 1-7
        • Schubert MM
        • Mark M
        • Correa MEP
        • Peterson DE
        Oral complications. Hematopoietic cell transplantation.
        Thomas’ hematopoietic cell transplantation: stem cell transplantation. 2015; 1: 1242-1258https://doi.org/10.1002/9781118416426.ch101
        • Epstein JB
        • Raber-Durlacher JE
        • Wilkins A
        • Chavarria MG
        • Myint H.
        Advances in hematologic stem cell transplant: an update for oral health care providers.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 107: 301-312
        • Copelan EA.
        Hematopoietic stem-cell transplantation.
        N Engl J Med. 2006; 354: 1813-1826
        • Kuderer NM
        • Dale DC
        • Crawford J
        • Cosler LE
        • Lyman GH.
        Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients.
        Cancer. 2006; 106: 2258-2266
        • Brown J
        • Grudzen C
        • Kyriacou DN
        • et al.
        The emergency care of patients with cancer: setting the research agenda.
        Ann Emerg Med. 2016; 68: 706-711
        • Page RC
        • Eke PI.
        Case definitions for use in population-based surveillance of periodontitis.
        J Periodontol. 2007; 78: 1387-1399
        • Williams RC.
        Periodontal disease.
        N Engl J Med. 1990; 322: 373-382
        • Peterson DE
        • Overholser CD.
        Increased morbidity associated with oral infection in patients with acute nonlymphocytic leukemia.
        Oral Surg Oral Med Oral Pathol. 1981; 51: 390-393
        • Reynolds MA
        • Minah GE
        • Peterson DE
        • et al.
        Periodontal disease and oral microbial successions during myelosuppressive cancer chemotherapy.
        J Clin Periodontol. 1989; 16: 185-189
        • Raber-Durlacher JE
        • Laheij AM
        • Epstein JB
        • et al.
        Periodontal status and bacteremia with oral viridans streptococci and coagulase negative staphylococci in allogeneic hematopoietic stem cell transplantation recipients: a prospective observational study.
        Support Care Cancer. 2013; 21: 1621-1627
        • Soga Y
        • Saito T
        • Nishimura F
        • et al.
        Appearance of multidrug-resistant opportunistic bacteria on the gingiva during leukemia treatment.
        J Periodontol. 2008; 79: 181-186
        • Laine PO
        • Lindqvist JC
        • Pyrhönen SO
        • Strand-Pettinen IM
        • Teerenhovi LM
        • Meurman JH.
        Oral infection as a reason for febrile episodes in lymphoma patients receiving cytostatic drugs.
        Eur J Cancer B Oral Oncol. 1992; 28B: 103-107
        • Soga Y
        • Yamasuji Y
        • Kudo C
        • et al.
        Febrile neutropenia and periodontitis: lessons from a case periodontal treatment in the intervals between chemotherapy cycles for leukemia reduced febrile neutropenia.
        Support Care Cancer. 2009; 17: 581-587
        • Raber-Durlacher JE
        • von Bültzingslöwen I
        • Logan RM
        • et al.
        Systematic review of cytokines and growth factors for the management of oral mucositis in cancer patients.
        Support Care Cancer. 2013; 21: 343-355
        • Raber-Durlacher JE
        • Epstein JB
        • Raber J
        • et al.
        Periodontal infection in cancer patients treated with high-dose chemotherapy.
        Support Care Cancer. 2002; 10: 466-473
        • O'Leary TJ
        • Drake RB
        • Naylor JE.
        The plaque control record.
        J Periodontol. 1972; 43: 38
      1. American Academy of Periodontology Task Force Report on the Update to the 1999 Classification of Periodontal Diseases and Conditions.
        J Periodontol. 2015; 86: 835-838
        • Oliveira AL
        • de Souza M
        • Carvalho-Dias VM
        • et al.
        Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients.
        Bone Marrow Transplant. 2007; 39: 775-781
        • Immunocompromised Host Society
        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. 1990; 161: 397-401
      2. Consensus statement: oral complications of cancer therapies. National Institutes of Health Consensus Development Panel.
        NCI Monogr. 1990; : 3-8
        • Fernandes LL
        • Torres SR
        • Garnica M
        • et al.
        Oral status of patients submitted to autologous hematopoietic stem cell transplantation.
        Support Care Cancer. 2014; 22: 15-21
        • Meurman JH
        • Pyrhönen S
        • Teerenhovi L
        • Lindqvist C.
        Oral sources of septicaemia in patients with malignancies.
        Oral Oncol. 1997; 33: 389-397
        • Bergmann OJ
        • Kilian M
        • Ellegaard J.
        Potentially pathogenic microorganisms in the oral cavity during febrile episodes in immunocompromised patients with haematologic malignancies.
        Scand J Infect Dis. 1989; 21: 43-51
        • Soga Y
        • Sugiura Y
        • Takahashi K
        • et al.
        Progress of oral care and reduction of oral mucositis—a pilot study in a hematopoietic stem cell transplantation ward.
        Support Care Cancer. 2010; 19: 303-307
        • Seto BG
        • Kim M
        • Wolinsky L
        • Mito RS
        • Champlin R.
        Oral mucositis in patients undergoing bone marrow transplantation.
        Oral Surg Oral Med Oral Pathol. 1985; 60: 493-497
        • Djuric M
        • Hillier-Kolarov V
        • Belic A
        • Jankovic L.
        Mucositis prevention by improved dental care in acute leukemia patients.
        Support Care Cancer. 2006; 14: 137-146
        • Toljanic JA
        • Bedard JF
        • Larson RA
        • Fox JP.
        A prospective pilot study to evaluate a new dental assessment and treatment paradigm for patients scheduled to undergo intensive chemotherapy for cancer.
        Cancer. 1999; 85: 1843-1848
        • Yoshinari N
        • Kameyama Y
        • Aoyama Y
        • Nishiyama H
        • Noguchi T.
        Effect of long-term methotrexate-induced neutropenia on experimental periodontal lesion in rats.
        J Periodontal Res. 1994; 29: 393-400
        • Milstein DM
        • Bezemer R
        • Lindeboom JA
        • Ince C.
        The acute effects of CMF-based chemotherapy on maxillary periodontal microcirculation.
        Cancer Chemother Pharmacol. 2009; 64: 1047-1052
        • Sultan AS
        • Zimering Y
        • Petruzziello G
        • et al.
        Oral health status and risk of bacteremia following allogeneic hematopoietic cell transplantation.
        Oral Surg Oral Med Oral Pathol. 2017; 124: 253-260
        • Auner HW
        • Sill H
        • Mulabecirovic A
        • Linkesch W
        • Krause R.
        Infectious complications after autologous hematopoietic stem cell transplantation: comparison of patients with acute myeloid leukemia, malignant lymphoma, and multiple myeloma.
        Ann Hematol. 2002; 81: 374-377
        • Collin BA
        • Leather HL
        • Wingard JR
        • Ramphal R.
        Evolution, incidence, and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients.
        Clin Infect Dis. 2001; 33: 947-953
        • 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.
        Support Care Cancer. 2012; 20: 367-373
        • Akintoye SO
        • Brennan MT
        • Graber CJ
        • et al.
        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. 2002; 94: 581-588
        • Cho SY
        • Lee HJ
        • Lee DG.
        Infectious complications after hematopoietic stem cell transplantation: current status and future perspectives in Korea.
        Korean J Intern Med. 2018; 33: 256-276
        • Gürgan CA
        • Özcan M
        • Karakuş Ö
        • et al.
        Periodontal status and post-transplantation complications following intensive periodontal treatment in patients underwent allogenic hematopoietic stem cell transplantation conditioned with myeloablative regimen.
        Int J Dent Hyg. 2013; 11: 84-90
        • Elad S
        • Garfunkel AA
        • Or R
        • Michaeli E
        • Shapira MY
        • Galili D.
        Time limitations and the challenge of providing infection-preventing dental care to hematopoietic stem-cell transplantation patients.
        Support Care Cancer. 2003; 11: 674-677
        • Nuernberg MA
        • Nabhan SK
        • Bonfim CM
        • Funke VA
        • Torres-Pereira CC.
        Access to oral care before hematopoietic stem cell transplantation: understand to improve.
        Support Care Cancer. 2016; 24: 3307-3313
        • Bucaneve G
        • Micozzi A
        • Menichetti F
        • et al.
        Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia.
        N Engl J Med. 2005; 353: 977-987