Oral Manifestations and Complications in Childhood Acute Myeloid Leukemia

Abstract

Acute myeloid leukemia (AML) is a heterogeneous group of diseases, whose classification is based on lineage-commitment and genetics. Although rare in childhood, it is the most common type of acute leukemia in adults, accounting for 80% of all cases in this age group. The prognosis of this disease remains poor (especially in childhood, as compared to acute lymphoblastic leukemia); however, overall survival has significantly improved over the past 30 years. The health of the oral cavity is a remarkable reflection of the systemic status of an individual. Identification of the signs and symptoms of oral lesions can act as a warning sign of hidden and serious systemic involvement. Moreover, they may be the presenting feature of acute leukemia and provide important diagnostic indicators. Primary oral alterations are identified in up to 90% of cases of acute myeloid leukemia and consist of petechiae, spontaneous bleeding, mucosal ulceration, gingival enlargement with or without necrosis, infections, hemorrhagic bullae on the tongue, and cracked lips. Poor oral hygiene is a well-known risk factor for local and systemic infectious complications. Oro-dental complications due to AML treatment can affect the teeth, oral mucosa, soft and bone tissue, and contribute to opportunistic infections, dental decay, and enamel discoloration. The treatment of acute myeloid leukemia is still associated with high mortality and morbidity. The management is multimodal, involving aggressive multidrug chemotherapy and, in most cases, allogenic bone marrow transplantation. Periodontal and dental treatment for patients with leukemia should always be planned and concerted with hematologists.

Leukaemic infiltration in the oral and maxillofacial region: An update

“…It is well known that poor hygiene can exacerbate gingival growth due to endotoxins released by pathogenic bacteria that elevate the levels of inflammatory cytokines. 15 Shankarapillai et al 20 reported that gingival growth was observed in three quarters of AML patients, probably associated with poor hygiene. Similarly, oral bleeding associated with poor hygiene that frequently occurs in the gingiva has been previously described in 15 patients with AML and ALL.…”

“…The acute form is abrupt and aggressive with primitive blasts cells in the peripheral blood and activation of mechanisms of tissue infiltration, while the chronic form is linked to a prolonged course and the presence of more mature cells. 11,15 Nevertheless, both may occur in the myeloid and lymphoid lineage and demographic differences among affected individuals have been observed. 15 Acute leukaemia usually affects children or young adults, 15 as also observed in this study.…”

“…11,15 Nevertheless, both may occur in the myeloid and lymphoid lineage and demographic differences among affected individuals have been observed. 15 Acute leukaemia usually affects children or young adults, 15 as also observed in this study. By contrast, a study found that the median age of individuals with acute leukaemia was 61 years.…”

“…19 Gingiva is most often associated with leukaemic infiltration possibly because of its own microanatomy. 15 However, the mechanisms explaining gingival involvement are poorly defined. It is well known that poor hygiene can exacerbate gingival growth due to endotoxins released by pathogenic bacteria that elevate the levels of inflammatory cytokines.…”

Integrative Analysis of Multi-Omics Identified the Prognostic Biomarkers in Acute Myelogenous Leukemia

“…Acute myelogenous leukemia (AML) is a common pediatric hematologic cancer in children younger than 15 years ( 1 , 2 ). In the past several years, the survival rate for AML has increased because of the improvement of therapeutic strategies, risk stratification, and supportive care ( 3 , 4 ).…”