Post-allogeneic Hematopoietic Stem Cell Transplantation (HSCT) changes in inorganic salivary components

Abstract

Recent studies have considered the qualitative and quantitative assessment of salivary flow, as well the biochemical components of saliva, as possible biomarkers that might contribute to the pathogenesis of chronic graft-versus-host disease (cGHVD) in hematopoietic stem cell transplantation (HSCT) patients. The aim of this study was to evaluate prospectively the inorganic salivary status at different periods of allogeneic HSCT. Saliva collection and oral examination were performed prior to the HSCT, ​between days 8 and 10, days 80 and 100, and at the cGVHD onset. Concentrations of calcium (Ca), phosphate (Pi), chloride (Cl), magnesium (Mg), potassium (K), and sodium (Na) were performed using colorimetric reactions and atomic absorption. Fifty-five consecutive patients undergoing first allogeneic HSCT were included in this study. Between days 8 and 10, the salivary flow rate was significantly higher (p = 0.05), Pi concentration was decreased (p = 0.007), and Na and Cl were increased (p = 0.001 and p = 0.001, respectively), compared with the baseline. Salivary flow rate during the same period showed a negative correlation with Pi concentration (p = 0.02) and a positive correlation with Na and Cl concentrations (p = 0.003 and p = 0.001, respectively). The salivary flow rate was decreased between days 80 and 100 (p = 0.02) and Na, Cl, and K concentrations were increased (p = 0.03, p = 0.02, and p = 0.003, respectively). Salivary flow rate showed a negative correlation with Na and Cl (p = 0.01 and p = 0.013, respectively). At cGVHD onset, the salivary flow rate showed no statistical difference compared with the other studied periods. A trend was observed in the higher Na concentration compared with the baseline (p = 0.06) and Pi concentration presented a significant decrease (p = 0.004). Ca and Mg concentrations showed no changes during all evaluation periods. The present study showed changes in inorganic salivary components in post-HSCT periods, mainly during the early period post-HSCT and at the cGVHD onset. We speculate that Na, Cl, and Pi in saliva could be used as a potential biomarker in further studies.

Common oral diseases, hyposalivation and survival post‐HSCT, a longitudinal study

“…Our study cannot thoroughly confirm this previous finding. Likewise, a couple of studies with a 100‐day follow‐up did not notice any changes in DMFT index or an increase in new dental caries lesions in this short follow‐up period . However, in this study, hyposalivation was observed to be associated with progression towards a higher DMFT index score.…”

“…Only a few studies exist on the oral health of adult subjects pre‐ and post‐HSCT. These studies suggest hyposalivation to be common and oral health to deteriorate after the HSCT . Additionally, there are no studies on the effects of hyposalivation or the most common oral infections caries and periodontitis on survival post‐HSCT.…”

Early salivary changes in multiple myeloma patients undergoing autologous HSCT

“…Most other studies measuring salivary flow rate after HSCT found a decrease in salivary flow rate (Amaral et al., ; Avivi et al., ; Boer, Correa, Tenuta, Souza, & Vigorito, ; Elad et al., ; Nagler, Barness‐Hadar, Lieba, & Nagler, ). However, one study found no changes in UWS flow rate in autologous HSCT patients, while a study in allogeneic patients showed an increase in UWS flow rate 8‐10 days after HSCT (Avivi et al., ; Boer et al., ). This increase might be related to dysphagia resulting in an increased resting volume of saliva as suggested by the authors (Boer et al., ).…”

“…However, one study found no changes in UWS flow rate in autologous HSCT patients, while a study in allogeneic patients showed an increase in UWS flow rate 8‐10 days after HSCT (Avivi et al., ; Boer et al., ). This increase might be related to dysphagia resulting in an increased resting volume of saliva as suggested by the authors (Boer et al., ).…”

Biology of chronic graft-vs-host disease: Immune mechanisms and progress in biomarker discovery

“…The alterations in the salivary proteome among proteins involved in innate and acquired immunity are consistent with the clinical features of oral cGVHD, in particular patient susceptibility to bacterial and viral infections[4,18]. Changes in inorganic salivary components, especially Na + and Cl - ions and inorganic phosphate, also occur in concert with cGVHD onset, correlating with hyposalivation and damage to the salivary glands[82,83]. …”