1
|
Nunes Duarte AC, Barbosa AN, Saito CPB, Paula EVD, Saito D. Oral mucositis and microbial status in acute lymphoblastic leukemia subjects undergoing high-dose chemotherapy. BRAZILIAN JOURNAL OF ORAL SCIENCES 2023. [DOI: 10.20396/bjos.v22i00.8667697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Aim: To assess oral microbial status in patients with acute lymphoblastic leukemia (ALL) undergoing high-dose chemotherapy and to unravel possible associations between nosocomial pathogens and the establishment of chemotherapy-induced oral mucositis (CIOM). Methods: Oral mucosa, saliva, and peripheral blood samples were collected from 46 ALL subjects one day prior to chemotherapy (D0) and 2 weeks after treatment initiation (D14). Clinical intraoral inspection was performed by a single practitioner, with mucositis classification performed according to the WHO oral toxicity scale. Blood components were quantified by automatic flow cytometry, while oral Staphylococcus aureus and Pseudomonas aeruginosa were detected by Polymerase Chain Reaction with species-specific primers. Associations among bacteria and clinical findings were determined by Fisher’s Exact test, longitudinal bacterial changes by paired Macnemar, and correlations among blood parameters and mucositis status or bacteria via Mann-Whitney. Results: S. aureus displayed higher detection rates at D14 (p < 0.05) and was positively associated with mucositis, adoption of a non-solid diet (all p < 0.001), nausea and fever (all p < 0.05). Conversely, P. aeruginosa did not correlate to CIOM clinical parameters. At the systemic standpoint, lower hemoglobin levels associated with CIOM and fever events (all p < 0.01). Conclusion: The study evidences S. aureus as a potential pathogen in ALL-CIOM, reaffirming microbial control as an important preventive measure during high-dose immunosuppressive therapy. The weight of non-white-blood-cell parameters should be validated as novel CIOM biomarkers in prospective research.
Collapse
|
2
|
Satheeshkumar PS, Blijlevens N, Sonis ST. Application of big data analyses to compare the impact of oral and gastrointestinal mucositis on risks and outcomes of febrile neutropenia and septicemia among patients hospitalized for the treatment of leukemia or multiple myeloma. Support Care Cancer 2023; 31:199. [PMID: 36869162 DOI: 10.1007/s00520-023-07654-1] [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: 10/27/2022] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Oral ulcerative mucositis (UM) and gastrointestinal mucositis (GIM) have been associated with increased likelihood of systemic infection (bacteremia and sepsis) in patients being treated for hematological malignancies. To better define and contrast differences between UM and GIM, we utilized the United States 2017 National Inpatient Sample and analyzed patients hospitalized for the treatment of multiple myeloma (MM) or leukemia. METHODS We utilized generalized linear models to assess the association between adverse events-UM and GIM-among hospitalized MM or leukemia patients and the outcome of febrile neutropenia (FN), septicemia, burden of illness, and mortality. RESULTS Of 71,780 hospitalized leukemia patients, 1255 had UM and 100 GIM. Of 113,915 MM patients, 1065 manifested UM and 230 had GIM. In an adjusted analysis, UM was significantly associated with increased risk of FN in both the leukemia (aOR = 2.87, 95% CI = 2.09-3.92) and MM cohorts (aOR = 4.96, 95% CI = 3.22-7.66). Contrastingly, UM had no effect on the risk of septicemia in either group. Likewise, GIM significantly increased the odds of FN in both leukemia (aOR = 2.81, 95% CI = 1.35-5.88) and MM (aOR = 3.75, 95% CI = 1.51-9.31) patients. Similar findings were noted when we restricted our analysis to recipients of high-dose condition regimens in preparation for hematopoietic stem-cell transplant. UM and GIM were consistently associated with higher burden of illness in all the cohorts. CONCLUSION This first use of big data provided an effective platform to assess the risks, outcomes, and cost of care of cancer treatment-related toxicities in patients hospitalized for the management of hematologic malignancies.
Collapse
Affiliation(s)
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Stephen T Sonis
- Dana Faber Cancer Institute, Boston, MA, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.,Primary Endpoint Solutions, Waltham, MA, USA
| |
Collapse
|
3
|
Rodríguez-Fuentes ME, Pérez-Sayáns M, Carreras-Presas CM, Marichalar-Mendia X, Bagán-Debón L, López-López R. Prevalence of acute oral mucosal damage secondary to the use of systemic antineoplastics: A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:385-395. [PMID: 36585342 DOI: 10.1016/j.oooo.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of acute oral mucosal toxicities in non-irradiated patients treated with systemic antineoplastics agents. The secondary objective was to find out differences in its prevalence among the different types of systemic antineoplastics. STUDY DESIGN A systematic review and meta-analysis was performed. Articles from 2010 to July 2022 were retrieved and included if patients were adults undergoing oral assessment after administration of commercially available systemic antineoplastics. Data was extracted and pooled proportions were estimated using random-effect model method (Der Simonian and Lair). RESULTS Eighty-two articles were included in the study. The overall prevalence of acute oral mucosal damage across studies was 38.2% (95% CI: 33.1%-43.3%). The prevalence was 42.9% (95% CI: 32.8%-53%) in patients treated with chemotherapy alone, 38% (95% CI: 29.1%-47%) in patients treated with a combination of chemotherapy and targeted therapies, and 32.1% (95% CI: 26.8%-37.5%) in targeted therapies alone-treated patients. No statistically significant differences were found in the prevalence of oral mucosal toxicities between the different types of systemic antineoplastic treatments. CONCLUSIONS Oral mucosal toxicity is a major side effect in non-irradiated cancer patients undergoing systemic antineoplastics.
Collapse
Affiliation(s)
- Manuel Eros Rodríguez-Fuentes
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain.
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain.
| | | | - Xabier Marichalar-Mendia
- Department of Nursing I, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Leticia Bagán-Debón
- Department of Stomatology, Faculty of Medicine and Dentistry-INCLIVA, Valencia, Spain
| | - Rafael López-López
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Medical Oncology Unit, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| |
Collapse
|
4
|
Jena S, Hasan S, Panigrahi R, Das P, Mishra N, Saeed S. Chemotherapy-associated oral complications in a south Indian population: a cross-sectional study. J Med Life 2022; 15:470-478. [PMID: 35646189 PMCID: PMC9126462 DOI: 10.25122/jml-2021-0342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022] Open
Abstract
Over the years, chemotherapy (CT) has evolved as an essential therapeutic modality for cancer, with oral manifestations frequently encountered as complications of cancer CT. Our study aimed to assess the prevalence of oral complications during CT and evaluate the significance of independent risk factors (age, gender, socio-economic status, oral hygiene practices etc). A cross-sectional study was carried out in a tertiary cancer hospital in Bhubaneswar, Odisha, India, in which a total of 138 hospitalized patients undergoing CT and fulfilling the inclusion and exclusion criteria were included. Comprehensive history and rigorous clinical examination eliciting the oral manifestations were carried out. Around 60% of patients exhibited oral manifestations. Xerostomia and lichenoid reactions were the highest and lowest recorded manifestations. Higher frequencies of oral lesions occurred in patients with breast cancer, TNM stage III, and with the administration of the docetaxel. Also, patients in the older age group, poor socio-economic status, poor quality of life, poor oral hygiene practices, and longer CT duration demonstrated more oral lesions. Individuals subjected to a dental evaluation either before or during CT exhibited a reduction in the number of oral features. Several oral complications were reported in the present study. All patients undergoing chemotherapy must receive reinforcement of oral hygiene instructions and dental evaluation before, during, and after chemotherapy treatment. The study also emphasizes the importance of oral health physician inclusion in the multidisciplinary cancer treatment team.
Collapse
Affiliation(s)
- Suvranita Jena
- Department of Oral Medicine and Radiology, SCB Dental College and Hospital, Cuttack, India
| | - Shamimul Hasan
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Rajat Panigrahi
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Siksha' O' Anusandhan University, Bhubaneswar, India
| | - Pinali Das
- Department of Oral Medicine and Radiology, SCB Dental College and Hospital, Cuttack, India
| | - Namrata Mishra
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Siksha' O' Anusandhan University, Bhubaneswar, India
| | - Shazina Saeed
- Amity Institute of Public Health, Amity University, Noida, India,Corresponding Author: Shazina Saeed, Amity Institute of Public Health, Amity University, Noida, India. E-mail:
| |
Collapse
|
5
|
Reliability of Screening Methods to Diagnose Oral Dryness and Evaluate Saliva Secretion. Dent J (Basel) 2020; 8:dj8030102. [PMID: 32887247 PMCID: PMC7558334 DOI: 10.3390/dj8030102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022] Open
Abstract
In this study, we evaluated the reliability and reproducibility of widely implemented salivary flow rate and oral dryness tests. In experiment 1, twenty young and healthy Japanese participants volunteered to participate. For each participant, the oral moisture (OM) level, unstimulated whole saliva volume (U-WSV), and stimulated whole saliva volume (S-WSV) were measured at the same time on two separate days. In experiment 2, twenty-seven patients who were over 65 years of age volunteered to participate. The OM level and U-WSV were measured at the same time on two separate days. In Experiment 1, the intra-class correlation coefficients (ICCs) corresponding to the S-WSV, U-WSV, and OM level were 0.23, 0.28, and 0.16, respectively, for the young participants. In Experiment 2, the ICCs corresponding to the U-WSV/spitting and OM level were 0.83 and 0.12, respectively, for the older participants. The results of Bland–Altman analysis confirmed the absence of systematic error, with the exception of the OM level results in Experiment 2, which indicated systematic bias. In conclusion, we believe that there is currently no consistent and reliable screening test for assessing salivary flow rate and oral dryness, although the spitting test was determined to be highly reliable.
Collapse
|
6
|
Villafuerte KRV, Martinez CDJH, Dantas FT, Carrara HHA, dos Reis FJC, Palioto DB. The impact of chemotherapeutic treatment on the oral microbiota of patients with cancer: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:552-566. [DOI: 10.1016/j.oooo.2018.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/31/2018] [Accepted: 02/10/2018] [Indexed: 01/01/2023]
|
7
|
Distinct shifts in the oral microbiota are associated with the progression and aggravation of mucositis during radiotherapy. Radiother Oncol 2018; 129:44-51. [PMID: 29735410 DOI: 10.1016/j.radonc.2018.04.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Oral mucositis remains one of the most common complications of radiation therapy for patients with head and neck cancer. This study aimed to investigate the dynamic shifts in the oral mucosal microbiota and their association with the progression and aggravation of mucositis in patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy. MATERIALS AND METHODS In this study, oropharyngeal mucosa of patients were examined regularly, and sampled longitudinally in eight stages of their radiation treatment program: before radiation, and then after 10, 20, 30, 40, 50, 60, and 70 Gy. Based on 16S rRNA gene sequencing and bioinformatics analysis, the characteristics of dynamic variations in oral microbiota during their treatment were investigated. RESULTS The results showed that the mucosal bacterial alpha diversity (richness and evenness) did not change significantly during the entire course of these patient treatments. Notwithstanding 20 genera were found to be significantly positively associated with their radiation dose, whereas 10 genera were negatively associated with it. Notably, two bacterial co-abundance groups (CAG 1 and 2) were identified and the majority of bacteria clustered within the CAG 2 were indeed periodontal disease-associated genera. Most strikingly, many of them, especially Prevotella, Fusobacterium, Treponema and Porphyromonas, showed obvious dynamic synchronous variations in their abundances throughout the course of radiation therapy, where their peaks frequently coincided with the onset of severe mucositis. CONCLUSION Our results suggest that dysbiosis of oral mucosal microbiota may contribute to exacerbating the severity of mucositis in patients undergoing radiotherapy for nasopharyngeal carcinoma.
Collapse
|