The Microbiome in Childhood Acute Lymphoblastic Leukemia

For almost 30 years, the term "holobiont" has referred to an ecological unit where a host (e.g., human) and all species living in or around it are considered together. The concept highlights the complex interactions between the host and the other species, which, if disturbed may lead to disease and premature aging. Specifically, the impact of microbiome alterations on the etiology of acute lymphoblastic leukemia (ALL) in children is not fully understood, but has been the focus of much research in recent years. In ALL patients, significant reductions in microbiome diversity are already observable at disease onset. It remains unclear whether such alterations at diagnosis are etiologically linked with leukemogenesis or simply due to immunological alteration preceding ALL onset. Regardless, all chemotherapeutic treatment regimens severely affect the microbiome, accompanied by severe side effects, including mucositis, systemic inflammation, and infection. In particular, dominance of Enterococcaceae is predictive of infections during chemotherapy. Long-term dysbiosis, like depletion of Faecalibacterium, has been observed in ALL survivors. Modulation of the microbiome (e.g., by fecal microbiota transplant, probiotics, or prebiotics) is currently being researched for potential protective effects. Herein, we review the latest microbiome studies in pediatric ALL patients.

Gingival health in children in the different phases of acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL), the most common type of leukemia in children, has diverse oral cavity complications. While periodontal alterations in such patients are widely known, there were no studies evaluating gingival health from the time of diagnosis to the remission phase. In our study, we, therefore, analysed the frequency of periodontal diseases and the gingival indices in the different phases of ALL in children. Children aged 7-15 years were involved into the cross-sectional study. Therein, 160 children with ALL were divided into three groups: L1 – 50 children examined before the initiation phase, L2 – 50 children examined after 1 month of the chemotherapy, L3 – 60 children examined in permanent hematologic remission. The control (HC) included 150 healthy children. The L1, L2 and L3 groups had significantly worse gingival indices and frequency of gingivitis than the HC group (p < 0.0001). Frequency of gingivitis increased from before the initiation to the remission phase, but significantly only in 7-11 year-old children (p = 0.0004). Gingival indices increased after 1 month of chemotherapy (p < 0.0001), but decreased in the permanent remission phase (p < 0.0001).

Our study stresses the need for children with ALL to not only require prevention courses before the initiation and during the chemotherapy phases, but also in the permanent remission phase to minimize the long-term impact of leukemia treatment on gingival health.

Unique Factors Affecting the Management and Prevention of Caries in the Childhood Cancer Survivor

Childhood cancer survivors are at high risk for a myriad of complications secondary to oncologic treatment regimens. Caries is one of the major sequela of oncologic treatment that place the childhood cancer survivor at risk for complications in adulthood. Dental caries can be prevented with optimum dental care, early identification, and patient education. A barrier to their prevention is the lack of routine dental care received by this population. Health care providers are in a prime position to remedy this problem through their frequent contact with the childhood cancer survivor during sick and well-child office visits. The purpose of this article is to convey information and tools related to dental caries in the pediatric cancer survivor younger than 18 years to enhance primary care providers', acute care pediatric nurse practitioners', and oncology providers' knowledge of risk stratification, early identification, and treatment regimens for caries in the childhood cancer survivor.