Oral manifestations in stem cell transplantation for acute myeloid leukemia

Myeloid sarcoma with maxillary gingival swelling as the initial symptom: A case report and review of literature

BACKGROUND

Myeloid sarcoma (MS), also referred to as granulocytic sarcoma or chloroma, is a rare type of extramedullary malignant tumor. MS comprises primitive granulocytic precursor cells that play a key role in the early stages of white blood cell development. Notably, the occurrence of this tumor in the gingiva is rare.

CASE SUMMARY

The present study reported the case of MS with gingival swelling in the maxillary region, with aleukemic presentation in a 32-year-old male patient. Following two courses of chemotherapy, computed tomography of the region demonstrated complete clearance of the tumor. At the 12-month follow-up appointment, the patient was in a stable condition with the absence of progression. The etiology, clinical features, diagnosis, and relevant treatment of MS are discussed in the present study.

CONCLUSION

Diagnosis of MS may be confirmed following histological and immunohistochemical examinations.

Bleeding disorders in implant dentistry: a narrative review and a treatment guide

Purpose

Considering a high prevalence of congenital and especially acquired bleeding disorders, their heterogeneity and the multitude of possible treatments strategies, a review of the scientific data on this topic is needed to implement a treatment guide for healthcare professionals.

Methods

A selective literature review was performed via PubMed for articles describing oral surgery / dental implant procedures in patients with congenital and acquired bleeding disorders. Out of the existing literature, potential treatment algorithms were extrapolated.

Results

In order to assess the susceptibility to bleeding, risk stratification can be used for both congenital and acquired coagulation disorders. This risk stratification, together with an appropriate therapeutic pathway, allows for an adequate and individualized therapy for each patient. A central point is the close interdisciplinary cooperation with specialists. In addition to the discontinuation or replacement of existing treatment modalities, local hemostyptic measures are of primary importance. If local measures are not sufficient, systemically administered substances such as desmopressin and blood products have to be used.

Conclusions

Despite the limited evidence, a treatment guide could be developed by means of this narrative review to improve safety for patients and practitioners. Prospective randomized controlled trials are needed to allow the implementation of official evidence-based guidelines.

Structural Changes in Resin-Based Composites in Saliva of Patients with Leukemia before Starting Chemotherapeutic Regimen

Background: The aim of this in vitro study was to assess the morphological characteristics and stability of dental composites immersed in saliva collected from patients with leukemia. Material and Methods: A total number of five patients without systemic disease and 20 patients with leukemia (acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML)) were included for saliva sampling. Composite disks were immersed in the leukemia, control, and artificial environments for 7 days. At the end of the experiment, atomic force microscopy (AFM), color stability (ΔE), and saliva elements analysis were performed. Statistical significance was considered for a p-value under 0.05. Results: The most changed surface resulted for ALL with a roughness that was almost double that of the untreated sample and was significantly increased compared to the healthy saliva. The effect of CLL was not as intense as observed for acute leukemia, but was significantly over the control. ALL seemed to modify structural components of the saliva, which were able to deteriorate the surface of the composite. ALL saliva promoted a significant dissolution of the initial feature of the samples and promoted nano-particle clusterization. All dental composites showed clinically acceptable color change values (ΔE < 3.3) in all four-leukemia salivas; CLL and CML showed large color differences for all composites. The total concentrations of P, Na, and K showed wide ranges of variations, while the coefficient of variation in Fe, Cu, and Mg showed narrow variations between the salvias’ investigated. The salivary concentration of zinc decreased considerably in the CLL and CML environments compared to the ALL and AML environments. Fe and Cu were significantly increased in the CML environment. Conclusions: Control and artificial salivas have a mild erosive effect on the surface of dental composites. The acute stage of the disease seems to deteriorate the surface roughness rather than its morphology, however, in the chronic stage, it is the surface morphology that mostly deteriorates.

Characteristics of Dental Resin-Based Composites in Leukemia Saliva: An In Vitro Analysis

BACKGROUND

The aim was to analyze, in vitro, four resin based composite systems (RBCs) immersed in saliva of leukemia patients before starting chemotherapy regiments.

MATERIAL AND METHODS

Saliva was collected from 20 patients (4 healthy patients, 16 leukemia patients). Resin disks were made for each RBC and were immersed in the acute leukemia (acute lymphocytic (ALL), acute myeloid (AML)), chronic leukemia (chronic lymphocytic (CLL), chronic myeloid (CML)), Artificial saliva and Control environment, and maintained for seven days. At the end of the experiment, the characteristics and the effective response of saliva from the studied salivas' on RBCs was assessed using water sorption, water solubility, residual monomer and scanning electron microscopy (SEM). Data analysis was performed and a p-value under 0.05 was considered statistically significant.

RESULTS

The behaviour of RBCs in different immersion environments varies according to the characteristics of the RBCs. RBCs with a higher filler ratio have a lower water sorption. The solubility is also deteriorated by the types of organic matrix and filler; the results of solubility being inversely proportional on the scale of negative values compared to sorption values. Chromatograms of residual monomers showed the highest amount of unreacted monomers in ALL and AML, and the Control and artificial saliva environments had the smallest residual monomer peaks. Because of the low number of differences between the experimental conditions, we further considered that there were no important statistical differences between experimental conditions and analysed them as a single group.

CONCLUSION

The influence of saliva on RBCs depends on the type of leukemia; acute leukemia influenced the most RBCs by changing their properties compared to chronic leukemia.

Topical Corticosteroids a Viable Solution for Oral Graft Versus Host Disease? A Systematic Insight on Randomized Clinical Trials

Background and Objectives: This research attempts to provide a clear view of the literature on randomized clinical trials (RCTs) concerning the efficacy of topical dexamethasone, clobetasol and budesonide in oral graft versus host disease (GVHD). Materials and Methods: An electronic search of the PubMed, Web of Science and Scopus databases was carried out for eligible RCTs. Studies were included if they had adult patients with oral GVHD treatment with topical corticosteroids, and if the RCT study was published in English. The Cochrane Risk of Bias tool was used to assess the quality of these studies. Overall, three RCTs were included (an Open, Randomized, Multicenter Trial; a Randomized Double-Blind Clinical Trial; and an Open-Label Phase II Randomized Trial). Results: The trials involved 76 patients, of which 44 patients received topical dexamethasone, 14 patients received topical clobetasol and 18 patients received topical budesonide. Topical agents were most frequently used when oral tissues were the sole site of involvement. It appears that the best overall response is present for budesonide with no difference between the four arms, followed by clobetasol, and then by dexamethasone. The limitation of the current study is mainly represented by the fact that overall response was derived in two of the studies from other parameters. Moreover, both budesonide and clobetasol were used in only one study each, while two assessed dexamethasone. Conclusions: Based on the clinical trials, all three agents seem to be effective in treating oral GVHD and had a satisfactory safety profile. There is still a need for assessing high quality RCTs to assess the efficacy of these therapies on a larger cohort.

A systematic approach on the frequency of cleft lip/palate in pediatric patients with leukemia

PURPOSE

The purpose of this study was to reveal the frequency between cleft lip/palate and leukemia in pediatric patients by a systematic analysis of the current literature.

MATERIALS AND METHODS

Electronic search on three database (PubMed, Web of Science, Cochrane) was carried out using the following keywords: cleft lip, cleft palate, facial cleft, oral cleft, orofacial cleft, leukemia, acute myeloid leukemia, acute lymphocytic leukemia, lymphoma. Studies published until March 2020 reporting an association between leukemia and cleft lip/palate (CL/P) were included in our research.

RESULTS

Five articles (2 case-controls, 3 cohorts), met the inclusion criteria. Case-control studies involved 268 patients with acute lymphocytic leukemia (ALL) and 177 patients with acute myeloid leukemia (AML), of which 9 patients had CL/P. The cohorts studies involved 10 patients with ALL, of which 6 patients with CL/P, 2 patients with cleft palate and 1 patient with cleft lip and palate.

CONCLUSION

This research was able to indicate a limited evidence of the association between CL/P and leukemia. In order to draw a clear conclusion, studies with larger cohorts are needed to establish this correlation.

Oral Manifestations and Complications in Childhood Acute Myeloid Leukemia

Acute myeloid leukemia (AML) is a heterogeneous group of diseases, whose classification is based on lineage-commitment and genetics. Although rare in childhood, it is the most common type of acute leukemia in adults, accounting for 80% of all cases in this age group. The prognosis of this disease remains poor (especially in childhood, as compared to acute lymphoblastic leukemia); however, overall survival has significantly improved over the past 30 years. The health of the oral cavity is a remarkable reflection of the systemic status of an individual. Identification of the signs and symptoms of oral lesions can act as a warning sign of hidden and serious systemic involvement. Moreover, they may be the presenting feature of acute leukemia and provide important diagnostic indicators. Primary oral alterations are identified in up to 90% of cases of acute myeloid leukemia and consist of petechiae, spontaneous bleeding, mucosal ulceration, gingival enlargement with or without necrosis, infections, hemorrhagic bullae on the tongue, and cracked lips. Poor oral hygiene is a well-known risk factor for local and systemic infectious complications. Oro-dental complications due to AML treatment can affect the teeth, oral mucosa, soft and bone tissue, and contribute to opportunistic infections, dental decay, and enamel discoloration. The treatment of acute myeloid leukemia is still associated with high mortality and morbidity. The management is multimodal, involving aggressive multidrug chemotherapy and, in most cases, allogenic bone marrow transplantation. Periodontal and dental treatment for patients with leukemia should always be planned and concerted with hematologists.

Periodontal disease might be a risk factor for graft versus host disease. A systematic review

PURPOSE

The aim of this systematic review was to determine a potential association between periodontal disease and graft versus host disease (GVHD).

DESIGN

PubMed, Scopus and Web of Science databases were searched to identify all relevant articles. The eligibility criteria were prospective, retrospective, cross-sectional, cohort, case-control studies and interventional studies that assessed periodontal parameters in GVHD adults' patients.

RESULTS

Seven studies, published between 2000 and 2018, were eligible. The aggravation of periodontal tissues is due to inadequate oral hygiene, dental plaque, decays, gum recession, retained roots, tooth loss, periodontally infected teeth. Several studies have indicated that periodontitis treatment performed before transplantation showed the reduction of gingival inflammation and maintenance of periodontal health.

CONCLUSIONS

Periodontitis might be a risk factor for GVHD. However, due to the limited number of studies included in the review and their heterogeneity, more data are needed to sustain the correlation between periodontitis and GVHD.