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Liu D, Luo X, Jing Y, Wu T, Chen F. The Application of PBM Therapy in Patients Subjected to Oral GVHD: A Review. Photobiomodul Photomed Laser Surg 2024. [PMID: 38900719 DOI: 10.1089/pho.2023.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
Background: Oral graft-versus-host disease (GVHD) is characterized by mucosal lesions, salivary gland dysfunction etc., accompanied by pain and oral dysfunction. The efficacy of photobiomodulation (PBM) in managing pain and inflammation has been demonstrated. PBM has been applied in oral GVHD and is regarded as a potent adjunctive therapy. Objective: To review the application of PBM for oral GVHD and summarize its biological mechanisms and recommended parameters. Materials and Methods: The article provides an overview of the therapeutic effects of PBM in oral GVHD cases. It analyzes the biological mechanisms from different aspects and explores the potential prospects of PBM, and appropriate parameters and frequency for GVHD are recommended. Conclusions: The efficacy of PBM in oral GVHD has been demonstrated through symptom alleviation and function improvement. It is recommended as an adjuvant therapy for oral GVHD. However, further research is required to explore optimal devices, parameters, and potential complications associated with using PBM in oral GVHD.
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Affiliation(s)
- Dongqi Liu
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering, Chongqing, China
| | - Xiao Luo
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering, Chongqing, China
| | - Yin Jing
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering, Chongqing, China
| | - Tingting Wu
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering, Chongqing, China
| | - Fangchun Chen
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering, Chongqing, China
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2
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Oleksak P, Nepovimova E, Valko M, Alwasel S, Alomar S, Kuca K. Comprehensive analysis of prohibited substances and methods in sports: Unveiling trends, pharmacokinetics, and WADA evolution. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2024; 108:104447. [PMID: 38636744 DOI: 10.1016/j.etap.2024.104447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/24/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
This review systematically compiles sports-related drugs, substances, and methodologies based on the most frequently detected findings from prohibited lists published annually by the World Anti-Doping Agency (WADA) between 2003 and 2021. Aligned with structure of the 2023 prohibited list, it covers all proscribed items and details the pharmacokinetics and pharmacodynamics of five representatives from each section. Notably, it explores significant metabolites and metabolic pathways associated with these substances. Adverse analytical findings are summarized in tables for clarity, and the prevalence is visually represented through charts. The review includes a concise historical overview of doping and WADA's role, examining modifications in the prohibited list for an understanding of evolving anti-doping measures.
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Affiliation(s)
- Patrik Oleksak
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove 500 03, Czech Republic
| | - Eugenie Nepovimova
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove 500 03, Czech Republic
| | - Marian Valko
- Faculty of Chemical and Food Technology, Slovak University of Technology, Bratislava 812 37, Slovakia; Zoology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Saleh Alwasel
- Zoology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Suliman Alomar
- Doping Research Chair, Zoology Department, College of Science, King Saud University, Riyadh-11451, Kingdom of Saudi Arabia.
| | - Kamil Kuca
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove 500 03, Czech Republic; Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI), University of Granada, Granada 18071, Spain.
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3
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Braun A, Gouni S, Pulles A, Strati P, Minnema MC, Budde LE. Bispecific Antibody Use in Patients With Lymphoma and Multiple Myeloma. Am Soc Clin Oncol Educ Book 2024; 44:e433516. [PMID: 38935881 DOI: 10.1200/edbk_433516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
This article endeavors to navigate the clinical journey of bispecific antibodies (BsAbs), from elucidating common toxicities and management strategies to examining novel agents and broadening access in community health care. These drugs, commonly through T-cell activation, result in shared adverse events such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. Variations in target antigens and designs, however, might introduce unique toxicities for different BsAbs, warranting specific management approaches. Recent US Food and Drug Administration approvals of BsAbs targeting CD3+ T cells linked to CD20 for non-Hodgkin lymphoma and to B-cell maturation antigen or GPRC5D for multiple myeloma have transformed the treatment landscape for hematologic malignancies. Emerging new agents promise further enhancement and safety, exploring novel antigen targets, innovative structures such as trispecific antibodies, and the engagement of diverse immune cells. Simultaneously, the expansion of BsAbs into community practices is underway, demanding a multifaceted strategy that encompasses educational initiatives, operational adaptations, and collaborative frameworks. This ensures comprehensive treatment access, allowing every patient, irrespective of geographical or socioeconomic status, to benefit from these advancements in cancer therapy.
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Affiliation(s)
- Adam Braun
- City of Hope National Medical Center, Duarte, CA
| | | | - Astrid Pulles
- Department of Rheumatology & Clinical Immunology, Utrecht University, Utrecht, the Netherlands
| | - Paolo Strati
- MD Anderson Comprehensive Cancer Center, Houston, TX
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
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Miranda M, Gianfreda F, Carlotta D, Armati S, Barlattani A, Bollero P. Oral Manifestations of Graft vs. Host Disease: A Comprehensive Review for Best Practice in Dentistry. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1937. [PMID: 38003987 PMCID: PMC10673022 DOI: 10.3390/medicina59111937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/15/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023]
Abstract
Graft-versus-host disease (GVHD) is a complication of hematopoietic stem cell transplantation (HSCT). GVHD may also develop following solid transplants or blood transfusions if white blood cells are transferred. GVHD affects multiple organs, including the oral tissues. This pictorial review provides a background of GVHD to dental practitioners, describes the most common oral manifestations of GVHD, and highlights the main treatment modifications needed to deliver dental care to patients with GVHD. A narrative review enriched with clinical data was performed by searching the scientific literature for all articles regarding GVHD and oral manifestations/therapies. All articles without exclusion criteria, except animal tests, were included in the above review. Acute GVHD may manifest in the oral mucosa; however, it often develops immediately following HSCT when routine dental treatment is postponed. Chronic GVHD may manifest in the oral mucosa, the salivary glands, and the musculoskeletal compartment. It may indirectly affect the teeth and the oral flora, putting the patient at risk for infections. Importantly, GVHD poses an increased risk for oral cancer. GVHD has a wide range of oral manifestations, some of which may affect dental treatment.
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Affiliation(s)
- Michele Miranda
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Francesco Gianfreda
- Department of Industrial Engineering, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | - Sofia Armati
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Alberta Barlattani
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Patrizio Bollero
- Department of System Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
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Santos PSDS, Granzotto FCN, Antunes HS, de Lima EM, Varanda RDF, Maccari K, Bezinelli LM, Melo WR, Junior LAVS, De Macedo LD, Eduardo FDP. Dentistry consensus on HSCT - Part III: Special topics - Dentistry on HSCT. Hematol Transfus Cell Ther 2023; 45:379-386. [PMID: 37328345 PMCID: PMC10499586 DOI: 10.1016/j.htct.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/17/2023] [Indexed: 06/18/2023] Open
Abstract
Patients undergoing hematopoietic stem cell transplantation (HSCT) might present acute and late toxicities and the oral tissues are frequently affected. With the survival increasing, patients show late and long-term morbidities, and there is an important association between the general and the oral health. The first and second parts of this Consensus have showed the importance of the adequacy of oral health in the pre-HSCT, and the main alterations and oral care during the period of admission for HSCT. This third part aims to review specific themes of post-HSCT dental care, such as graft-versus-host disease (GVHD) and the pediatric patient. It also aims to review pertinent subjects, both during the HSCT period and post-HSCT, concerning quality of life, pain, cost-effectiveness, and remote care. Based on this review, it is evident the importance of the work of the dental surgeon (DS) in the follow-up and treatment of the HSCT patient, always collaborating with the whole multidisciplinary team.
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Affiliation(s)
- Paulo Sérgio da Silva Santos
- Departamento de Cirurgia, Estomatologia, Patologia e Radiologia da Faculdade de Odontologia de Bauru da Universidade de São Paulo, Bauru, São Paulo, Brazil
| | | | - Héliton Spindola Antunes
- Coordenação de Pesquisa Clínica do Instituto Nacional do Câncer, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Karina Maccari
- Serviço de Odontologia do Hospital de Amor, Barretos, São Paulo, Brazil
| | | | - Walmyr Ribeiro Melo
- Odontologia Hospitalar - Hospital Samaritano do Grupo Américas, São Paulo, Brazil
| | | | - Leandro Dorigan De Macedo
- Serviço de Odontologia e Estomatologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil; Faculdade de Medicina de Ribeirão Preto-USP, Ribeirao Preto, São Paulo, Brazil
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6
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Epstein JB, Hernandez RS, Nakamura R, Yost SE, Ali H. Oral Chronic Graft-versus-Host Disease in Post-Hematopoietic Stem Cell Transplant Patients Following SARS-CoV-2 Vaccination: Case Reports. Case Rep Oncol 2023; 16:1287-1292. [PMID: 37928865 PMCID: PMC10624449 DOI: 10.1159/000533821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/24/2023] [Indexed: 11/07/2023] Open
Abstract
Patients receiving allogeneic hematopoietic stem cell transplant may experience graft-versus-host disease (GVHD) in which donor immune cells cause an immune reaction in host tissues. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccines are highly effective in prevention of severe coronavirus-2019 (COVID-19) disease, but the vaccine can result in immune activation and GVHD. Herein, we report 4 cases of oral manifestations that may have been stimulated by COVID-19 or vaccination with Pfizer or Moderna vaccines. We believe this study is the first to report oral changes driven by an inflammatory/immune mechanism leading to oral symptomatic cGVHD. The clinical impact of this study is early recognition and appropriate management of oral symptomatic cGVHD following COVID-19 disease or SARS-CoV-2 vaccination.
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Affiliation(s)
- Joel B. Epstein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Raymond S. Hernandez
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Susan E. Yost
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Farahani M, Nirouei M, Moghadam S, Hashemnejad M, Mashak B, Alinia T, Torabi S. The Effect of Using Dexamethasone Tablets Vaginally for Improving Cervical Bishop Score in Nulliparous Pregnant Women: A Randomized Clinical Trial. CURRENT THERAPEUTIC RESEARCH 2023; 98:100702. [PMID: 37101983 PMCID: PMC10124091 DOI: 10.1016/j.curtheres.2023.100702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/25/2023] [Indexed: 04/28/2023]
Abstract
Background Cervix ripening and labor induction are common interventions in obstetrics. For optimal maternal health, labor may be induced under certain situations to improve fetal survival outcomes. Labor induction of an unripe cervix can lead to complications; therefore, several approaches can facilitate the ripening process. Methods This randomized clinical trial was a triple-blind study that involved 84 pregnant nulliparous women enrolled between October 2019 and June 2021 in the labor ward of Kamali Hospital, Karaj, Iran. The pregnant women in the study underwent labor induction and were randomized into 2 groups: 1 group received vaginal dexamethasone and the other group was given a placebo. Results There was no significant difference between the groups regarding maternal age, demographic characteristics, and initial Bishop score. The median second Bishop score (6 hours after intervention) was 3.5 in dexamethasone recipients and 3 in placebo recipients (P = 0.48). The median labor latent phase duration was 4 hours in dexamethasone recipients and 5 hours in placebo recipients (P = 0.57). Conclusions This randomized clinical trial demonstrated that administering dexamethasone tablets vaginally did not significantly improve cervical Bishop scores. (Curr Ther Res Clin Exp. 2023; 84:XXX-XXX). ClinicalTrials.gov identifier: NCT05070468.
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Affiliation(s)
- Masoumeh Farahani
- Department of Obstetrics and Gynecology, Alborz University of Medical Sciences, Karaj, Iran
| | - Matineh Nirouei
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Somaye Moghadam
- School of Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| | - Maryam Hashemnejad
- Department of Obstetrics and Gynecology, Alborz University of Medical Sciences, Karaj, Iran
| | - Banafsheh Mashak
- Department of anesthesiology, Alborz University of Medical Sciences, Karaj, Iran
| | - Tina Alinia
- School of Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Torabi
- School of Midwifery, Alborz University of Medical Sciences, Karaj, Iran
- Address correspondence to: Sahar Torabi (Bachelor of Midwifery), School of Midwifery, Alborz University of Medical Sciences, Buali Street, Karaj, Iran.
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Anti-inflammatory mouthwashes for the prevention of oral mucositis in cancer therapy: an integrative review and meta-analysis. Support Care Cancer 2022; 30:7205-7218. [PMID: 35486227 DOI: 10.1007/s00520-022-07068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Mucositis is severely painful and often reported as one of the most distressing adverse effects of cancer therapy; it is a significant threat to quality of life as well as life itself. Anti-inflammatory agents may modulate physiologic mechanisms that perpetuate mucositis and be useful in prevention efforts. Because systemic anti-inflammatory agents are not appropriate for many patients, locally acting agents (mouthwashes) may be more feasible for use. This review and meta-analysis evaluates the role that anti-inflammatory mouthwashes have in preventing or reducing oral mucositis associated with chemotherapy and radiation therapy. METHODS A systematic literature review was conducted to identify studies evaluating the efficacy of anti-inflammatory mouthwashes to prevent therapy-associated mucositis. Meta-analysis was conducted to determine efficacy in preventing any mucositis and dose-limiting mucositis. RESULTS Eight peer-reviewed publications were identified; corticosteroid and nonsteroidal anti-inflammatory mouthwashes are effective in reducing overall incidence of mucositis and are associated with lower severity of mucositis. Meta-analysis reveals significant reduction in symptomatic mucositis incidence (OR 6.00, 95% CI 4.39-8.20, p < 0.0001) and reduction of dose-limiting mucositis (OR 2.12, 95% CI 1.07-4.28, p = 0.032). CONCLUSION Mouthwashes containing anti-inflammatory agents are a potential effective means to prevent or reduce mucositis associated with cancer therapy. There are limited adverse effects from these agents, and adherence is high, indicating safety and feasibility of use. Anti-inflammatory mouthwashes should be considered for supportive care in persons at risk for mucositis and must be further evaluated to investigate efficacy across multiple chemotherapy agents, adverse effects, and impacts on symptoms, pain, and quality of life.
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Novel Adhesive Nanocarriers Based on Mussel-Inspired Polyglycerols for the Application onto Mucosal Tissues. Pharmaceutics 2022; 14:pharmaceutics14050940. [PMID: 35631526 PMCID: PMC9144514 DOI: 10.3390/pharmaceutics14050940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
A synthetic route for adhesive core-multishell (CMS) nanocarriers for application to the oral mucosa was established using mussel-inspired catechol moieties. The three CMS nanocarriers with 8%, 13%, and 20% catechol functionalization were evaluated for loading capacity using Nile red, showing an overall loading of 1 wt%. The ability of Nile red loaded and functionalized nanocarriers to bind to a moist mucosal surface was tested in two complementary adhesion assays under static and dynamic conditions using monolayers of differentiated gingival keratinocytes. Adhesion properties of functionalized nanocarriers were compared to the adhesion of the non-functionalized nanocarrier. In both assays, the CMS nanocarrier functionalized with 8% catechol exhibited the strongest adhesion compared to its catechol-free counterpart and the CMS nanocarriers functionalized with 13% and 20% catechol.
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10
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Scaraficci AC, Fernandes PM, Abreu Alves F, Filho JS, Jaguar GC. Oral manifestations of graft-versus-host disease in patients submitted to allogeneic hematopoietic stem cell transplantation: the experience of a Brazilian Cancer Center. Support Care Cancer 2021; 30:567-573. [PMID: 34341851 DOI: 10.1007/s00520-021-06349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Graft-versus-host disease (GVHD) is an important complication of allogeneic hematopoietic stem cell transplantation (AHCT) that affects several organs, including the mouth. OBJECTIVES The aim of the present study was to describe the prevalence and clinical manifestations of oral GVHD, to determine the time interval from AHCT to the onset of oral GVHD manifestations, to identify predictive factors of oral GVHD, and to evaluate the survival rates of patients diagnosed with oral GVHD. METHODS Medical records of 147 patients who underwent AHCT between January 2010 and January 2015 were reviewed for clinical features and the statistical establishment of risk factors. RESULTS Of the 147 patients in the study, 99 (67.3%) developed GVHD. The skin was the most affected site (45.6%), followed by the gastrointestinal tract (27.9%) and oral cavity (17.7%). The mean post-AHCT oral GVHD development time was 229 days. Among patients with oral GVHD, pain was the main complaint (96.2%) followed by xerostomia (65.4%). The most common oral manifestations were ulcers (53.8%) followed by striae-associated ulcers (19.2%), mostly affecting the buccal mucosa and tongue. Seventy-three patients (48.6%) died within 20 months of receiving AHCT. Cox regression analysis indicated that patients who received myeloablative conditioning regimen had higher survival rate than those who underwent a reduced-intensity conditioning regimen (RR = 0.541; 95% CI, 0.334-0.878; p = 0.03). CONCLUSION The mouth was the third most common GVHD-affected site. Pain, xerostomia, and ulcers with or without striae were the main clinical manifestations of GVHD observed in our study cohort. Reduced-intensity conditioning regimen showed significant relationship with mortality risk.
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Affiliation(s)
- Ana Cláudia Scaraficci
- Stomatology Department, A.C. Camargo Cancer Center, Rua Prof. Antônio Prudente, 211 - Liberdade, São Paulo, SP, 01509-010, Brazil
| | - Patrícia Maria Fernandes
- Stomatology Department, A.C. Camargo Cancer Center, Rua Prof. Antônio Prudente, 211 - Liberdade, São Paulo, SP, 01509-010, Brazil
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas - UNICAMP - Piracicaba, Piracicaba, Brazil
| | - Fabio Abreu Alves
- Stomatology Department, A.C. Camargo Cancer Center, Rua Prof. Antônio Prudente, 211 - Liberdade, São Paulo, SP, 01509-010, Brazil
| | - Jayr Schmidt Filho
- Department of Hematology, Hematopoietic Stem Cell Transplant Unit, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Graziella Chagas Jaguar
- Stomatology Department, A.C. Camargo Cancer Center, Rua Prof. Antônio Prudente, 211 - Liberdade, São Paulo, SP, 01509-010, Brazil.
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11
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Dommisch H, Stolte KN, Jager J, Vogel K, Müller R, Hedtrich S, Unbehauen M, Haag R, Danker K. Characterization of an ester-based core-multishell (CMS) nanocarrier for the topical application at the oral mucosa. Clin Oral Investig 2021; 25:5795-5805. [PMID: 33821321 PMCID: PMC8443517 DOI: 10.1007/s00784-021-03884-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/11/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Topical drug administration is commonly applied to control oral inflammation. However, it requires sufficient drug adherence and a high degree of bioavailability. Here, we tested the hypothesis whether an ester-based core-multishell (CMS) nanocarrier is a suitable nontoxic drug-delivery system that penetrates efficiently to oral mucosal tissues, and thereby, increase the bioavailability of topically applied drugs. MATERIAL AND METHODS To evaluate adhesion and penetration, the fluorescence-labeled CMS 10-E-15-350 nanocarrier was applied to ex vivo porcine masticatory and lining mucosa in a Franz cell diffusion assay and to an in vitro 3D model. In gingival epithelial cells, potential cytotoxicity and proliferative effects of the nanocarrier were determined by MTT and sulphorhodamine B assays, respectively. Transepithelial electrical resistance (TEER) was measured in presence and absence of CMS 10-E-15-350 using an Endohm-12 chamber and a volt-ohm-meter. Cellular nanocarrier uptake was analyzed by laser scanning microscopy. Inflammatory responses were determined by monitoring pro-inflammatory cytokines using real-time PCR and ELISA. RESULTS CMS nanocarrier adhered to mucosal tissues within 5 min in an in vitro model and in ex vivo porcine tissues. The CMS nanocarrier exhibited no cytotoxic effects and induced no inflammatory responses. Furthermore, the physical barrier expressed by the TEER remained unaffected by the nanocarrier. CONCLUSIONS CMS 10-E-15-350 adhered to the oral mucosa and adhesion increased over time which is a prerequisite for an efficient drug release. Since TEER is unaffected, CMS nanocarrier may enter the oral mucosa transcellularly. CLINICAL RELEVANCE Nanocarrier technology is a novel and innovative approach for efficient topical drug delivery at the oral mucosa.
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Affiliation(s)
- H Dommisch
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 14197, Berlin, Germany. .,Department of Periodontology, University of Washington, Seattle, WA, USA.
| | - K N Stolte
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 14197, Berlin, Germany
| | - J Jager
- Institute for Biochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
| | - K Vogel
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 14197, Berlin, Germany
| | - R Müller
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 14197, Berlin, Germany
| | - S Hedtrich
- Pharmacology and Toxicology, Institute of Pharmacy, Freie Universität Berlin, 14195, Berlin, Germany.,Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada
| | - M Unbehauen
- Institute for Chemistry and Biochemistry, Freie Universität Berlin, 14195, Berlin, Germany
| | - R Haag
- Institute for Chemistry and Biochemistry, Freie Universität Berlin, 14195, Berlin, Germany
| | - K Danker
- Institute for Biochemistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
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12
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Photobiomodulation (low-level laser) therapy for immediate pain relief of persistent oral ulcers in chronic graft-versus-host disease. Support Care Cancer 2021; 29:4529-4534. [PMID: 33474595 DOI: 10.1007/s00520-021-05997-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/12/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine the immediate pain-relieving effect of photobiomodulation therapy (PBMt) in patients with oral ulcers of chronic graft-versus-host disease (cGVHD) refractory to first line therapy with topical corticosteroids. METHODS This retrospective study included all patients who underwent PBMt for pain relief of refractory oral cGVHD lesions. PBMt was applied using an intraoral approach to all sites with mucosal lesions, using a 940 nm InGaAsP diode laser device, with the following parameters: pulsed modulation (duty cycle of 50%), power 0.7 W, illuminated spot size 7.1 cm2, irradiance 98.6 mW/cm2, and irradiation time 90 s per point. Pain was self-assessed using a 0-to-10 scale immediately before and after PBMt. RESULTS Data from eleven patients with a total of 56 PBMt sessions were analyzed. In 48 (85.7%) sessions, the patients reported less pain immediately after treatment, with a reduction of ≥ 50% of the initial pain level in 43 (76.8%) sessions. Mean pre- and post-treatment pain levels were 5.20 ±2.7 and 1.38 ±2.1, respectively (p < 0.001), i.e., a post-treatment reduction of 73.4% of the initial pain level. The benefits of the treatment remained for a mean of 6.50 ±5.4 days (range of 2 to 14 days). No adverse effects were reported. CONCLUSIONS PBMt seems to be a promising treatment modality for refractory oral cGVHD lesions as a rapid pain reliever with relatively long-lasting effects.
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Elad S, Aljitawi O, Zadik Y. Oral Graft-Versus-Host Disease: A Pictorial Review and a Guide for Dental Practitioners. Int Dent J 2021; 71:9-20. [PMID: 33616057 PMCID: PMC9275209 DOI: 10.1111/idj.12584] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Graft-versus-host disease (GVHD) is a complication of haematopoietic stem cell transplantation (HSCT). GVHD may also develop following solid transplants or blood transfusions if white blood cells are transferred. GVHD affects multiple organs, including the oral tissues. OBJECTIVE This pictorial review provides a background of GVHD to dental practitioners, describes the most common oral manifestations of GVHD and highlights the main treatment modifications needed to deliver dental care to patients with GVHD. METHODS A narrative review enhanced with clinical photographs. RESULTS Acute GVHD may manifest in the oral mucosa; however, it often develops immediately following HSCT when routine dental treatment is postponed. Chronic GVHD may manifest in the oral mucosa, the salivary glands and the musculoskeletal compartment. It may indirectly affect the teeth and the oral flora, putting the patient at risk for infections. Importantly, GVHD poses an increased risk for oral cancer. CONCLUSION GVHD has a wide range of oral manifestations, some of which may affect dental treatment.
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Affiliation(s)
- Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
| | - Omar Aljitawi
- Department of Hematology and Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Yehuda Zadik
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Abstract
Purpose of Review Graft-versus-host disease (GVHD) is an immune mediated disorder affecting 30 - 70% of patients after allogeneic hematopoietic stem cell transplantation (alloHSCT), and is a major cause of morbidity and non-relapse mortality (NRM) [1]. Dermatologists play a critical role in acute and chronic GVHD, as skin involvement is common and often the earliest involved site of disease [2]. Recent Findings GVHD shares clinical and histopathological features with a variety of other skin diseases, requiring thorough consideration of differential diagnoses in hematopoietic stem cell transplantation (HSCT) recipients with lesions suggestive of cutaneous GVHD. Treatment considerations for GVHD are influenced by factors such as disease classification, overall grading, organ involvement, associated symptoms, and immunological anti-tumor effect. Several treatments are available and may be indicated as monotherapy or adjuvant therapy to allow faster withdrawal or tapering of immunosuppression. While corticosteroids are often first line therapy, oral ruxolitinib has been recently approved for treatment of steroid-refractory aGHVD, and oral ibrutinib has been approved for steroid-refractory cGHVD. Summary This article provides current clinical, diagnostic, and therapeutic considerations relevant to the hospitalist for both acute and chronic mucocutaneous GVHD. Optimal inpatient management of these diseases requires an interdisciplinary team.
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Haverman TM, Raber-Durlacher JE, Raghoebar II, Rademacher WMH, Rozema FR, Hazenberg MD, Epstein JB, Treister NS. Oral chronic graft-versus-host disease: What the general dental practitioner needs to know. J Am Dent Assoc 2020; 151:846-856. [PMID: 33121606 DOI: 10.1016/j.adaj.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/13/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Long-term survivors of allogeneic hematopoietic cell transplantation will increasingly seek care from dental providers. METHODS The authors highlight the importance of minimizing oral symptoms and complications associated with oral chronic graft-versus-host-disease (cGVHD). RESULTS Chronic GVHD is the result of an immune response of donor-derived cells against recipient tissues. Oral cGVHD can affect the mucosa and damage salivary glands and cause sclerotic changes. Symptoms include sensitivity and pain, dry mouth, taste changes, and limited mouth opening. Risk of developing caries and oral cancer is increased. Food intake, oral hygiene, and dental interventions can represent challenges. Oral cGVHD manifestations and dental interventions should be managed in close consultation with the medical team, as systemic treatment for cGVHD can have implications for dental management. CONCLUSIONS General dental practitioners can contribute substantially to alleviating oral cGVHD involvement and preventing additional oral health deterioration. PRACTICAL IMPLICATIONS Frequent examinations, patient education, oral hygiene reinforcement, dry mouth management, caries prevention, and management of dental needs are indicated. In addition, oral physical therapy might be needed. Invasive dental interventions should be coordinated with the transplantation team. Screening for oral malignancies is important even years after resolution of GVHD symptoms. Management of the oral manifestations of cGVHD might require referral to an oral medicine professional.
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Leuci S, Coppola N, Blasi A, Ruoppo E, Bizzoca ME, Lo Muzio L, Marano L, Risitano AM, Mignogna MD. Oral Dysplastic Complications after HSCT: Single Case Series of Multidisciplinary Evaluation of 80 Patients. Life (Basel) 2020; 10:life10100236. [PMID: 33050268 PMCID: PMC7600275 DOI: 10.3390/life10100236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) is the most common secondary solid malignancy after hematopoietic stem-cell transplantation (HSCT). OSCC following HSCT is frequently preceded by chronic graft-versus-host disease (cGVHD). The aim of this study was to describe a cohort of post-HSCT patients and to evaluate the onset of oral epithelial dysplasia and/or OSCC over time. In this retrospective cohort study, we present a cohort of hematological patients that underwent HSCT. Demographic variables, clinical hematological data, data regarding acute graft-versus-host disease (aGVHD) and cGVHD, and oral clinical features were analyzed. We focused on clinicopathological features of a subgroup of 22 patients with oral cGVHD and OSCC after HSCT. Among 80 included patients, 46 patients (57.5%) developed aGVHD and 39 patients (48.7%) developed cGVHD. Oral mucosa was involved in 17 patients with aGVHD (36.9%) and in 22 patients (56.4%) with cGVHD. Out of a total of 22 oral biopsies, roughly 40% revealed mild to moderate dysplasia, and 32% were OSCC. In the absence of international agreement on the best timing of oral follow-up after HSCT, it is mandatory to establish a close multidisciplinary evaluation in order to prevent the onset of HSCT-related OSCC and to reduce post-transplant mortality due to secondary tumors.
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Affiliation(s)
- Stefania Leuci
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, Federico II University of Naples, 80138 Naples, Italy; (S.L.); (A.B.); (E.R.); (M.D.M.)
| | - Noemi Coppola
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, Federico II University of Naples, 80138 Naples, Italy; (S.L.); (A.B.); (E.R.); (M.D.M.)
- Correspondence: ; Tel.: +39-3392602615
| | - Andrea Blasi
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, Federico II University of Naples, 80138 Naples, Italy; (S.L.); (A.B.); (E.R.); (M.D.M.)
| | - Elvira Ruoppo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, Federico II University of Naples, 80138 Naples, Italy; (S.L.); (A.B.); (E.R.); (M.D.M.)
| | - Maria Eleonora Bizzoca
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.E.B.); (L.L.M.)
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.E.B.); (L.L.M.)
| | - Luana Marano
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80138 Naples, Italy;
| | | | - Michele Davide Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, Federico II University of Naples, 80138 Naples, Italy; (S.L.); (A.B.); (E.R.); (M.D.M.)
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Bar O, Elad S, Avni B, Abu-Tair J, Zaharia B, Hanut A, Zadik Y. Oral verruciform xanthoma in chronic graft-versus-host disease patients. Support Care Cancer 2020; 29:79-84. [PMID: 32803727 DOI: 10.1007/s00520-020-05681-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Verruciform xanthoma (VX) is an uncommon benign epithelial lesion which mainly appears in inflamed oral epithelium. In this study, our aim was to present new cases of oral VX (OVX) in chronic graft-versus-host disease (cGVHD) and review the literature. METHODS We conducted a retrospective chart review of cGVHD patients (2012-2019) to reveal cases of OVX. The demographics, medical background, clinical presentation, treatment provided, and follow-up were obtained. Additionally, Medline was searched using the terms "graft-versus-host disease," "verruciform xanthoma," and "oral." Of the articles, the above-mentioned demographic and clinical features were retrieved. RESULTS The patient pool included 133 oral cGVHD patients. Three cGVHD patients (males, aged 15-49 years, post-hematologic malignancy) were diagnosed with OVX. All patients had oral mucosal lichenoid lesions, but not in close proximity to the VX lesion. Medline searches revealed 9 cases of OVX in cGVHD patients reported in the literature. Eleven of the 12 patients had oral mucosal lichenoid lesions. Four patients had multiple OVX lesions. All lesions were asymptomatic. Six patients had lesions in the masticatory mucosa (hard palate and gingiva) and 4 patients had lesions in the buccal mucosa. CONCLUSIONS To the best of our knowledge, this is the largest published OVX in cGVHD series, including 12 patients. It appears that despite the higher prevalence in cGVHD patients relative to the general population, OVXs do not necessarily develop in sites with lichenoid lesions. It is advised that clinicians be familiar with the clinical and histological features in order to consider OVX in the differential diagnosis of oral lesions in cGVHD patients.
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Affiliation(s)
- Ori Bar
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Batia Avni
- Department of Bone Marrow Transplantation and Immunotherapy, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jawad Abu-Tair
- Department of Oral and Maxillofacial Surgery, Hebrew University-Hadassah School of Dental Medicine and Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Bianca Zaharia
- Department of Oral and Maxillofacial Surgery, Hebrew University-Hadassah School of Dental Medicine and Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Aiham Hanut
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yehuda Zadik
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel. .,Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel. .,Department of Military Medicine, Hebrew University-Hadassah School of Medicine, P.O. Box 12000, 91120, Jerusalem, Israel.
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18
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Gong W, Wang F, He Y, Zeng X, Zhang D, Chen Q. Mesenchymal Stem Cell Therapy for Oral Inflammatory Diseases: Research Progress and Future Perspectives. Curr Stem Cell Res Ther 2020; 16:165-174. [PMID: 32713335 DOI: 10.2174/1574888x15666200726224132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 02/08/2023]
Abstract
Mesenchymal stem cell (MSC) therapy for clinical diseases associated with inflammation and tissue damage has become a progressive treatment strategy. MSCs have unique biological functions, such as homing, immune regulation, and differentiation capabilities, which provide the prerequisites for the treatment of clinical diseases. Oral diseases are often associated with abnormal immune regulation and epithelial tissue damage. In this review, we summarize previous studies that use MSC therapy to treat various oral inflammatory diseases, including oral ulceration, allergic diseases, chemo/radiotherapy-induced oral mucositis, periodontitis, osteonecrosis of the jaw, Sjögren's syndrome (SS), among other similar diseases. We highlight MSC treatment as a promising approach in the management of oral inflammatory diseases, and discuss the obstacles that remain and must be overcome for MSC treatment to thrive in the future.
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Affiliation(s)
- Wang Gong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Fei Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yuqing He
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Dunfang Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
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Amy DPB, Shalabi A, Finfter O, Birenzweig Y, Zadik Y. Severe chronic nonlichenoid oral mucositis in pembrolizumab-treated patients: new cases and a review of the literature. Immunotherapy 2020; 12:777-784. [PMID: 32611271 DOI: 10.2217/imt-2019-0162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aim: To report of severe chronic oral mucositis (OM) in two pembrolizumab-treated cancer patients. Materials & methods: A retrospective chart review was performed. Inclusion/exclusion criteria detected patients that developed OM during pembrolizumab immunotherapy. In addition, we searched the literature for nonlichenoid OM in immunotherapy-treated cancer patients. Results: Two male patients treated for anaplastic astrocytoma and lung adenocarcinoma were included. Extensive painful OM (grade 4) developed in both patients during the course of immunotherapy and the ulcerations remained >30 weeks (>16 weeks after stopping immunotherapy). Superficial mucocele appeared in one patient. In one patient, pain relief was achieved with photobiomodulation (low-level laser) therapy. Conclusion: OM induced by immunotherapy may be a major cause of suffering and eating difficulties. In most cases, the OM lasted for months even after the drug was stopped. There is a controversy regarding the beneficial effect of corticosteroids on OM in these patients.
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Affiliation(s)
- Dalit Porat Ben Amy
- Oral Medicine Unit, Department of Oral & Maxillofacial Surgery, Baruch Padeh Medical Center, Poria, and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Akram Shalabi
- Oral Medicine Unit, Department of Oral & Maxillofacial Surgery, Baruch Padeh Medical Center, Poria, Israel.,Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Ori Finfter
- Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yonatan Birenzweig
- Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yehuda Zadik
- Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.,Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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20
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Zadik Y. Pharmacotherapy of oral mucosal manifestations of chronic graft-versus-host disease: When? What? and How? Expert Opin Pharmacother 2020; 21:1389-1392. [PMID: 32586149 DOI: 10.1080/14656566.2020.1763307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Yehuda Zadik
- Faculty of Medicine, The Hebrew University of Jerusalem , Jerusalem, Israel
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21
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Seminario-Vidal L, Kroshinsky D, Malachowski SJ, Sun J, Markova A, Beachkofsky TM, Kaffenberger BH, Ergen EN, Mauskar M, Bridges A, Calhoun C, Cardones AR, Chen ST, Chodosh J, Cotliar J, Davis MDP, DeNiro KL, Dominguez AR, Eljure-Téllez J, Femia A, Fox LP, Guda A, Mitchell C, Mostaghimi A, Ortega-Loayza AG, Owen C, Pasieka H, Rahnama-Moghadam S, Saeed HN, Saunderson RB, Shanbhag S, Sharon VR, Strowd L, Venkatesh S, Wanat KA, Wetter DA, Worswick S, Micheletti RG. Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults. J Am Acad Dermatol 2020; 82:1553-1567. [PMID: 32151629 DOI: 10.1016/j.jaad.2020.02.066] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 12/14/2022]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists, and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. Participants were administered 9-point Likert scale questionnaires regarding 135 statements. The RAND/UCLA Appropriateness Method was used to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5 to 9 and a disagreement index of ≤1 were included in the guideline. For the final round, the guidelines were appraised by all of the participants. Included are an evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN.
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Affiliation(s)
- Lucia Seminario-Vidal
- Department of Dermatology, University of South Florida, Morsani College of Medicine, Tampa, Florida; Cutaneous Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida.
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen J Malachowski
- Department of Internal Medicine, Medical College of Wisconsin Affiliated Hospitals, St. Joseph's Hospital, Milwaukee, Wisconsin
| | - James Sun
- Cutaneous Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Elizabeth N Ergen
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Melissa Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alina Bridges
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Cody Calhoun
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Adela R Cardones
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Chodosh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Cotliar
- Division of Dermatology, Harbor-University of California, Los Angeles Medical Center, Los Angeles, California
| | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | | - Arturo R Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Juliana Eljure-Téllez
- Department of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
| | - Alisa Femia
- Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Lindy P Fox
- Department of Dermatology, University of California, San Francisco, California
| | - Anisha Guda
- University of Texas Health San Antonio Long School of Medicine, San Antonio, Texas
| | - Caroline Mitchell
- Vincent Center for Reproductive Biology, Department of Obstetrics, Gynecology & Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Cindy Owen
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Helena Pasieka
- Department of Dermatology, MedStar Washington Hospital Center, Washington, DC
| | | | - Hajirah N Saeed
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Rebecca B Saunderson
- Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Swapna Shanbhag
- Tej Kohli Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India
| | - Victoria R Sharon
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Lindsay Strowd
- Department of Dermatology, Wake Forest University School of Medicine, Wake Forest, North Carolina
| | - Samantha Venkatesh
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karolyn A Wanat
- Department of Dermatology, University of Southern California, Los Angeles, California
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Scott Worswick
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert G Micheletti
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
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22
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Shazib MA, Muhlbauer J, Schweiker R, Li S, Cutler C, Treister N. Long-Term Utilization Patterns of Topical Therapy and Clinical Outcomes of Oral Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2020; 26:373-379. [PMID: 31585167 DOI: 10.1016/j.bbmt.2019.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
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23
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Mawardi H, Hashmi SK, Elad S, Aljurf M, Treister N. Chronic graft‐versus‐host disease: Current management paradigm and future perspectives. Oral Dis 2018; 25:931-948. [DOI: 10.1111/odi.12936] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/04/2018] [Accepted: 07/04/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Hani Mawardi
- Faculty of Dentistry King AbdulAziz University Jeddah Kingdom of Saudi Arabia
- AlFarabi Private College Jeddah Kingdom of Saudi Arabia
| | - Shahrukh K. Hashmi
- Department of Medicine Mayo Clinic Rochester Minnesota
- Oncology Center KFSHRC Riyadh Kingdom of Saudi Arabia
| | - Sharon Elad
- Department of Dentistry University of Rochester Rochester New York
| | | | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital Boston Massachusetts
- Department of Oral Medicine, Infection and Immunity Harvard School of Dental Medicine Boston Massachusetts
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24
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Mester A, Irimie A, Oprita L, Dima D, Petrushev B, Lucaciu O, Campian RS, Tanase A. Oral manifestations in stem cell transplantation for acute myeloid leukemia. Med Hypotheses 2018; 121:191-194. [PMID: 30396479 DOI: 10.1016/j.mehy.2018.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/15/2018] [Indexed: 12/16/2022]
Abstract
Acute myeloid leukemia is a highly aggressive malignancy with a high morbidity rate, for which an accurate and rapid diagnostic is essential. Acute myeloid leukemia manifestations frequently include oral abnormalities. Still, there is a limited number of studies reporting the incidence of oral manifestations in acute leukemia, the prevalence of periodontal status and periodontal parameters in these patients. Our aim was to emphasize the importance of early recognition by the dental practitioners of oral cavity manifestations as signs of acute myeloid leukemia, so that prompt referral to the hematologists is being done, and appropriate treatment is offered.
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Affiliation(s)
- Alexandru Mester
- School of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Alexandra Irimie
- School of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Liana Oprita
- School of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Bobe Petrushev
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania.
| | - Ondine Lucaciu
- School of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Radu-Septimiu Campian
- School of Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Alina Tanase
- Department of Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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