Prevalence and risk factors of oral mucositis in paediatric patients undergoing haematopoietic stem cell transplantation

Abstract

Background A complete understanding of oral mucositis (OM) is crucial to develop appropriate interventions to aid in the successful overall health outcome of paediatric patients undergoing haematopoietic stem cell transplantation (HSCT). Aims This study aimed at determining the prevalence and severity of OM and at identifying the predictive factors that might aggravate OM at one‐week, two‐week and three‐week post‐HSCT. Methods This retrospective, hospital‐based study reviewed the medical records of 170 paediatric patients, summarising the patients’ characteristics using descriptive statistics. Binary logistic regression was used to identify factors associated with the development of OM. Results At one‐week post‐HSCT, 41% of 140 patients (n = 49) had developed OM, this was reduced at two‐week (n = 36, 33%) and three‐week (n = 13, 19%) post‐HSCT. Univariate logistic regression revealed that patients with cancer (OR = 0.16, 95% CI = 0.05–0.54; p‐value = .003) had a significantly lower prevalence of OM. Younger patients with an average age of 7.9 years old (OR = 0.85, 95% CI = 0.75–0.97; p‐value = 0.013) and the presence of GvHD (OR = 2.37, 95% CI = 1.03–5.45, p‐value = 0.042) were significantly related to a higher prevalence of OM. Multivariable logistic regression confirmed that the risk of OM is lower in patients with cancer compared to those with immunodeficiency syndromes or hereditary blood diseases (OR = 0.18, 95% CI = 0.04–0.77; p‐value = .021). Conclusions This study identified a significantly lower prevalence of OM in patients with cancer compared to other conditions and that young recipients and those who developed GvHD were more likely to have OM.

Oral Mucositis and Nutritional Status in Children Who Underwent Hematopoietic Cell Transplantation: A Comparison Between Nonmalignant and Malignant Primary Diseases

“…This was expected, as the majority of NMD group had been exposed to nonmyeloablative and reduced toxicity conditioning. This finding contrasts with another study focused on children with cancer and primary immunodeficiencies [3], which identified a significantly higher risk of OM in children with immunodeficiencies. Probably the use of laser therapy may have influenced the results of mild OM severity in the NMD group.…”

“…When examining all the patients as a whole, we detected that the incidence of OM in our study (84.8%) was higher than that reported in other pediatric HSCT studies, which ranged from approximately 40.0% to 80.0% [3,4,[15][16][17]. This discrepancy was likely due to the inclusion of cases with mild erythema (classified as grade I by the dental team) in the overall frequency of OM observed in our study.…”

“…The HSCT in these cases may involve nonmyeloablative or reduced toxicity conditionings, which may impact on the OM frequency and severity. Interestingly, available data suggest that OM is severe in patients with primary immunodeficiencies [1, 3] and Fanconi anemia [9], even when conditioning regimens had low toxicity. In addition, nutritional imbalance has been reported in some studies focused on HSCT for nonmalignant disorders [10].…”

“…Managing OM in children can be difficult due to challenges in diagnosing oral lesions and accurately reporting oral pain.There is a lack of studies analyzing the factors associated with OM in children, particularly in pediatric HSCT patients. Although these studies did not provide detailed information on the frequency and severity of OM, they consistently found a high incidence of OM and identified myeloablative conditioning regimens and younger age as the primary risk factors for these lesions [1][2][3][4]. However, the impact of OM on a patient's nutritional status has been poorly addressed.…”

Influence of periodontal status on patients undergoing hematopoietic stem cell transplantation: A retrospective analysis

“…Their severity can vary from mucosal atrophy, swelling, and mild erythema to severe oral ulcers [ 22 ]. Previous studies have reported OM prevalence ranging 41%–100 % [ 2 , 3 , 13 , 19 , [23] , [24] , [25] ]. To date, consensus lacks on whether periodontal status affects OM incidence.…”