Intensity and duration of neutropenia relates to the development of oral mucositis but not odontogenic infection during chemotherapy for hematological malignancy

Abstract

BackgroundD-index which combines the intensity and duration of neutropenia is reported as a tool for evaluating the dynamics of neutropenia. This study aimed to analyze the relationship between D-index and oral complications (i.e., oral mucositis [OM] and odontogenic infection [OI]) during chemotherapies for hematological malignancies.MethodsA total of 421 chemotherapeutic courses in 104 patients were analyzed. Chemotherapeutic courses in patients who finished all of the prophylactic dental treatments were defined as “treatment Finish”. Chemotherapeutic courses in patients who did not finish prophylactic dental treatments were defined as “treatment not-Finish”. OM was evaluated according to the Common Terminology Criteria for Adverse Events, version 4.0. D-index was compared between chemotherapeutic courses with versus without oral complications.ResultsD-index was significantly higher in chemotherapeutic courses with grade 1 or 2 OM (p < 0.001) than courses without OM. In contrast, higher D-index did not relate to the development of OI (p = 0.18). The occurrence of OI (p < 0.001) but not OM (p = 0.56) during chemotherapy was significantly higher in chemotherapeutic courses without the completion of dental intervention.ConclusionsHigher D-index relates to the development of OM. In contrast, OI occurs due to untreated odontogenic foci, and its occurrence does not relate to higher D-index.

Dental intervention against osteoradionecrosis of the jaws in irradiated patients with head and neck malignancy: a single-arm prospective study

“…We previously proposed appropriate prophylactic dental extraction with consideration of the irradiation field and dose [20]. We also formulated a novel protocol for dental intervention by modifying a previous protocol [21] for patients who underwent hematopoietic stem cell transplantation for hematological malignancy, and we demonstrated the validity of our dental intervention protocol for patients who underwent myelosuppressive chemotherapy for hematological malignancy [22,23]. The primary purpose of the present single-arm prospective intervention study was to determine whether our dental intervention protocol has an impact on the prevention and treatment of ORN in patients undergoing irradiation for head and neck malignancy.…”

Management of oral mucositis in pediatric patients receiving cancer therapy: A systematic review and meta‐analysis

“…The oral mucosa consists of rapidly dividing cells that are especially susceptible to the damaging effects of cytotoxic therapy. Oral complications during chemotherapy and radiotherapy can arise from direct injury to the oral mucosa, but they also result from cytotoxic‐induced myelosuppression that produces profound neutropenia . Methotrexate (MTX) is a commonly used chemotherapeutic agent with documented activity against leukemia, lymphoma, and other malignancies.…”

“…Oral complications during chemotherapy and radiotherapy can arise from direct injury to the oral mucosa, but they also result from cytotoxic-induced myelosuppression that produces profound neutropenia. 3,4 Methotrexate (MTX) is a Abbreviations: ALL, acute lymphoblastic leukemia; HDMTX, high-dose MTX; HSCT, hematopoietic stem-cell transplantation; IL-1, interleukin-1; IL-13, interleukin-13; IL-6, interleukin-6; KGF, keratinocyte growth factor; LLLT, low-level laser therapy; MTX, methotrexate; OM, oral mucositis; PDGF, platelet-derived growth factor; TGF-, transforming growth factor-B; TNF-, tumor necrosis factor-alpha commonly used chemotherapeutic agent with documented activity against leukemia, lymphoma, and other malignancies. High-dose MTX (HDMTX) is vital in consolidation chemotherapy when treating pediatric patients with acute lymphoblastic leukemia (ALL), the most common childhood malignancy.…”

Perioperative intervention by oral medicine team in cardiovascular surgery patients

“…The importance of prechemotherapeutic oral intervention for patients with hematological malignancy is widely known [1]. Myelosuppressive chemotherapy for hematological malignancy or hematopoietic stem cell transplantation places patients in an immunocompromised state [2]. Odontogenic foci such as untreated deep dental caries, periodontitis, or erupted wisdom teeth can cause infection, possibly resulting in interruption of medical treatments or life-threatening septicemia [3].…”