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

Abstract

Hematopoietic stem cell transplantation (HSCT) is widely used as a potentially curative treatment for patients with various hematological malignancies, bone marrow failure syndromes, and congenital immune deficiencies. The prevalence of oral complications in both autologous and allogeneic HSCT recipients remains high, despite advances in transplant medicine and in supportive care. Frequently encountered oral complications include mucositis, infections, oral dryness, taste changes, and graft versus host disease in allogeneic HSCT. Oral complications are associated with substantial morbidity and in some cases with increased mortality and may significantly affect quality of life, even many years after HSCT. Inflammatory processes are key in the pathobiology of most oral complications in HSCT recipients. This review article will discuss frequently encountered oral complications associated with HSCT focusing on the inflammatory pathways and inflammatory mediators involved in their pathogenesis.

The need for endodontic treatment and systemic characteristics of hematopoietic stem cell transplantation patients

“…5 This study evaluated the need for endodontic treatment in patients before and after HSCT by analyzing their systemic data and correlating these data with the risk of persistent endodontic infections among HSCT recipients.…”

“…22 HSCT makes patients more susceptible to infection, as the oral cavity is a relevant source of pathogens likely to cause systemic disorders in this population. 5 It is believed that infections of oral origin occur in approximately 80% of cases. 11 Pulpal and periradicular diseases usually result from direct or indirect involvement of microorganisms present in the oral cavity.…”

“…Complications are associated with a substantial increase in morbidity, with significant impairment of the patient´s quality of life even many years after transplantation. 5 Complications derived from root canal infections might occur at any stage of the transplantation process and can cause significant problems, such as systemic infection or other disorders, which increase the cost and mortality rate associated with transplantation. 6 While in autologous HSCT transplantation most of these problems become minimized six months after the procedure; patients subjected to allogeneic transplantation might subsequently develop GVHD-related complications.…”

“…6 While in autologous HSCT transplantation most of these problems become minimized six months after the procedure; patients subjected to allogeneic transplantation might subsequently develop GVHD-related complications. 5 Prevention of systemic complications demands achieving stabilization or elimination of oral infection before the onset of transplantation or myelosuppressive therapy. 6 Additionally, the possible late consequences of total body irradiation and highdose chemotherapy in immunosuppressed patients are a cause of much concern.…”

Severe herpes simplex oral mucositis in a patient with non-Hodgkin’s lymphoma after autologous stem cells transplantation – Case Report

“…Viral infections of the oral mucosa are a serious complication of chemotherapy and radiotherapy in patients with haematologic malignancies [3,4]. Herpes simplex viruses are detected in 58-70% of haematology patients treated with intensive chemotherapy [5].…”