Longitudinal Assessment of Hematopoietic Stem Cell Transplantation and Hyposalivation

Abstract

Hyposalivation is a common adverse effect of anti-neoplastic therapy of head and neck cancer, causing impaired quality of life and predisposition to oral infections. However, data on the effects of hematopoietic stem cell transplantation (HSCT) on salivary secretion are scarce. The present study determined stimulated whole-saliva flow rates in HSCT recipients in comparison with a healthy control group. Stimulated whole-saliva flow rates of 228 allogeneic HSCT recipients (134 males, 94 females; mean age, 43 yrs) were examined pre-HSCT and 6, 12, and 24 months post-HSCT. Healthy individuals (n = 144; 69 males, 75 females; mean age, 46 yrs) served as the control group. Stimulated saliva flow rates (mL/min) were measured and analyzed statistically, stratifying for hematological diagnoses and conditioning therapy. Hyposalivation (≤ 0.7 mL/min) was found in 40% (p < 0.00001), 53% (p < 0.00001), 31% (p < 0.01), and 26% (n.s.) of the recipients pre-HSCT, and 6, 12, and 24 months post-HSCT, respectively, whereas 16% of the control individuals had hyposalivation. Severe hyposalivation (≤ 0.3 mL/min) was found in 11%, 18%, 4%, and 4% of the recipients pre-HSCT, and 6, 12, and 24 months post-HSCT, respectively. Additionally, conditioning regimen and sex had an impact on saliva flow. In conclusion, hyposalivation was observed to be a common but generally reversible complication among HSCT recipients.

Sicca symptoms and their impact on quality of life among very long-term survivors after hematopoietic SCT

“…[31][32][33] However, as observed in our previous study, even lower radiation doses (6 Â 2 Gy) used as conditioning therapy before HSCT may contribute to hyposalivation. 9 Comparable complications caused by TBI have been reported in other studies among adults and children. [34][35][36] In the current study, the observed hyposalivation may partly be due to permanent destruction and dysfunction of the glandular tissue caused by non-fractionated TBI, as 89% of the recipients had received such treatment.…”

“…8,30 In HSCT-treated patients, radiotherapy is likely to be one etiological factor for hyposalivation. 9 Hypofunction of salivary glands depends on the cumulative dose to the gland tissue, and exposure to high total radiation doses (426-36 Gy) leads to a significant reduction of salivary secretion. [31][32][33] However, as observed in our previous study, even lower radiation doses (6 Â 2 Gy) used as conditioning therapy before HSCT may contribute to hyposalivation.…”

“…8 In a recent study, objectively determined hyposalivation was found in B50% of patients 6 months post-HSCT. 9 In most cases, stimulated saliva flow returned to normal levels within 2 years, but some patients suffered from persisting hyposalivation. Another recent study by Hull et al 10 reported comparable salivary gland hypofunction and xerostomia 6 to 24 months post-HSCT.…”

Oral Complications in Hematopoietic Stem Cell Recipients: The Role of Inflammation

“…Patients with salivary gland cGvHD are at risk of developing complications because of diminished salivary defense mechanisms, including antifungal and anticariogenic activities [88, 89]. Castellarin and coworkers reported cGvHD-associated rapidly progressive dental caries with cervical and interproximal involvement [90].…”

Alterações estomatológicas de pacientes em preparo para transplante de células-tronco hematopoiéticas

“…As alterações radiográficas mais frequentes são microdontia generalizada, ausência de dentes por extrações e agenesias, transposições e supranumerários (ACIKGOZ et al, 2005;DE ARAUJO et al, 2007;TEKCICEK et al, 2007;DE ARAUJO et al, 2011;SHETTY et al, 2011 (STOOPLER et al, 2007;ISLAM et al, 2011). Na literatura investigada, as alterações estomatológicas mais frequentes nos pacientes em preparo para TCTH foram gengivite, acúmulo de biofilme, cálculo dentário, periodontite com bolsas profundas e perda significativa de osso alveolar, alto índice de cárie, redução de fluxo salivar, restaurações com infiltrações necessitando de retratamento, lesões periapicais, raízes residuais, dentes parcialmente irrompidos, mucosite, dor relacionada à articulação têmporo-mandibular, infecções oportunistas por fungos e vírus, infiltrado leucêmico gengival, petéquias, equimoses, língua saburrosa, úlceras traumáticas infectadas, erosão dental, hiperplasia ou hipertrofia gengival, alterações oclusais e na formação dos dentes após quimioterapia na infância (LUCAS et al, 1998;GRABER et al, 2001;MELKOS et al, 2003;VAUGHAN et al, 2005b;YAMAGATA et al, 2006;BRENNAN et al, 2008;DA SILVA SANTOS et al, 2008;DUREY et al, 2009;BOER et al, 2010;HONG et al, 2010;LAAKSONEN et al, 2011;PALMASON et al, 2011;GURGAN et al, 2012;HERNANDEZ-FERNANDEZ et al, 2012). A variedade de manifestações em diversos graus de intensidade é resultado do tempo variado entre o adoecimento e o momento do diagnóstico.…”