Eurich, C., Pinheiro, C., Kanaan, S., Silva, G. M., Amenábar, J. M., Carvalho, C. (2019). Evaluación longitudinal de la mucositis oral en el trasplante de células madre hematopoyéticas: un estudio piloto. Odontología Vital 30:31-38.

Evaluación longitudinal de la mucositis oral en el trasplante de células madre hematopoyéticas:un estudio piloto

Longitudinal evaluation of oral mucositis in

hematopoietic stem cell transplantation: a pilot study

Carolina Eurich Mazur, Federal University of Parana, Brasil, carolmazur6@hotmail.com

Camila Pinheiro Furquim, Federal University of Parana, Brasil, camilapfurquim@yahoo.com.br

Samir Kanaan Nabhan, Federal University of Parana, Brasil, samir.nabhan@hc.ufpr.br Geisla Mary Silva Soares, Federal University of Parana, Brasil, geisla.soares@ufpr.br José Miguel Amenábar, Federal University of Parana, Brasil, jamenaba@ufpr.br

Cassius Carvalho Torres-Pereira, Federal University of Parana, Brasil, cassius.torres@ufpr.br

RESUMEN

Objetivo: describir la incidencia y el puntaje de la mucositis oral (MO) y las morbilidades relacionadas en individuos sometidos a trasplante de células madre hematopoyéticas (TCMH) a lo largo del período de inmunosupresión. Métodos: Los sujetos con enfermedades onco / hematológicas, mayores de 14 años, sometidos a TCMH alogénico fueron evaluados diariamente por la presencia y clasificación de OM, nivel de dolor, disfagia, disgeusia y xerostomía. El examen comenzó dos días antes de la infusión de células madre hematopoyéticas y finalizó veinte días después. La OM se clasificó de acuerdo con la escala de la OMS y se utilizó la escala analógica visual (EVA) para medir el nivel de dolor. Resultados: se reclutaron 23 individuos, el 83% con enfermedades malignas y el 91% con OM. La mediana del grado máximo de OM fue 3 y el nivel máximo de dolor fue 9. Hubo una mediana de 11 días de uso de medicación opioide. Los sujetos que tuvieron el mayor número de días con dolor en la boca alcanzaron el grado máximo de OM y el mayor número de días y el uso de opioides. Conclusión: Hubo una alta incidencia y puntuaciones más altas de OM, pérdida de masa corporal y dolor en esta muestra.

PALABRAS CLAVE

Mucositis Oral; Trasplante de células madre; Neoplasmas hematológicos.

ABSTRACT

Aim: To describe the oral mucositis (OM)` incidence and score, and related morbidities in individuals submitted to Hematopoietic Stem Cell Transplantation (HSCT) throughout the immunosuppression period of time Methods: Subjects with onco / hematological diseases, older than 14 years, submitted to allogeneic HSCT were daily evaluated by the presence and classification of OM, pain level, dysphagia, dysgeusia and xerostomia. The examination started two days before the infusion of hematopoietic stem cells and ended twenty days later. The OM was classified according to the WHO scale and visual analog scale (VAS) was used to measure pain level Results: Twenty-three individuals were recruted, 83% with malignant diseases and 91% had OM. The median of maximum OM degree was 3 and the maximum pain level was 9. There was a median of 11 days of opioid medication use. The subjects who had the highest mean number of days with mouth pain reached the maximum degree of OM and higher number of days and opiod use. Conclusion: There was a high incidence and high scores of OM, loss of body mass and pain in this sample.

KEY WORDS

Oral mucositis; Stem Cell Transplantation; Haematological neoplasms.

Recibido: 22 agosto, 2018

Aceptado para publicar: 14 noviembre, 2018

ENERO - JUNIO 2019 ODONTOLOGÍA VITAL 31

Revista Odontología Vital Enero - Junio 2019. Año 17. Volumen 1, No. 30

INTRODUCTION

The Hematopoietic Stem Cell Transplantation (HSCT) is a thera- peutic procedure to treat onco / hematological diseases (Armitage, 1994; Lange et al., 2006; Ribeiro et al., 1996; Ruiz-Argüelles et al., 2015). Prior the infusion of hema- topoietic stem cells, an immuno- suppressant regimen is necessary for death of bone marrow cells and preparation for reconstitution (Armitage, 1994; Bacigalupo et al., 2009). The most often condition- ing regimens used for HSCT are reduced-intensity conditioning (RIC) and myeloablative (MA), and both can induce OM (Bacigalupo et al., 2009; Bardellini et al., 2013; Chaudhry et al., 2016; Turner et al., 2010). OM is an inflammation of gastrointestinal tract mucosa and its main cause is the chemothera- peutic conditioning prior to HSCT (Haverman et al., 2014; Stephen T Sonis, 2012; Stephen T. Sonis, 2012). OM can leave malnutrition, bacteremia, psychological altera- tions, increase of hospitalization days and, often, failure to finish

immunosuppressant regimen (Haverman et al., 2014; Peterson et al., 2011; Vera-Llonch et al., 2007)

. OM is commonly evaluated by World Health Organization (WHO) Scale, which considers objective

Table 1: Patients characteristics about medications,

disease and transplantation.

VARIABLE

n (%)

 

 

 

Sex

 

 

Male

12

(52)

Female

11

(48)

 

 

 

Disease

 

 

Malignant

19

(83)

Benign

4 (17)

 

 

 

Conditioning regimen

 

 

Myeloablative

21

(91)

Reduced Intensity Conditioning

2

(9)

 

 

 

Medications before HSCT

 

 

Chemotherapy

15

(65)

Immunosuppression

3 (13)

Tirosin Kinase Inhibitor

2

(9)

Azacitidin

1

(4)

No treatment

2

(9)

 

 

 

Transplantation type

 

 

Relatated Donor

11

(48)

Non-Related Donor

10

(42)

Haploidentical

2 (10)

 

 

 

HSCT source

 

 

Bone Marrow

19

(83)

Peripheral Blood

4 (17)

 

 

 

Immunoprophylaxis

 

 

CSA + MTX

20

(87)

CSA + MMF + CFA

3 (13)

 

 

 

Presence of oral mucositis

 

 

Yes

21

(91)

No

2

(9)

 

 

 

ECSA = Cyclosporin; MTX= Methotrexate; MMF= Mycophenolate; CFA= Cyclophospha- mide.

and subjective variables (WHO, 2017).

Although there are several clini- cal studies about OM, few studies evaluate OM daily during the im- munosuppressant period. In order to establish strategies to improve the patient’s quality of life during the immunosuppressive phase it is required to evaluate the OM degree and its consequences throughout this period. Therefore, the aim of this study was to describe the in- cidence, severity of oral OM and related morbidities in individuals submitted to HSCT throughout the immunosuppression period.

METHODS

DESIGN

This is a longitudinal descriptive study conducted at the Bone Mar- row Transplantation Unit of the Hospital de Clínicas of Federal University of Parana, Curitiba, Pa- rana, Brazil, and was approved by the local Research Ethics Review Committee ( number: 1.431.294).

Individuals’ recruitment was per- formed when they were at the be- ginning of the conditioning regi- men prior to HSCT.

SUBJECTS

Individuals with onco / hema- tological diseases, older than 14 years, both gender submitted to al- logeneic HSCT were invited to par- ticipate of the study.

The participants agreed and signed the Free and Informed Consent Term / Informed Assent Term. Data were collected from March to October 2016.

PROCEDURE

A trained dentist evaluated all par- ticipants. The presence and grade

32 ODONTOLOGÍA VITAL ENERO - JUNIO 2019

Eurich, C., Pinheiro, C., Kanaan, S., Silva, G. M., Amenábar, J. M., Carvalho, C. (2019). Evaluación longitudinal de la mucositis oral en el trasplante de células madre hematopoyéticas: un estudio piloto. Odontología Vital 30:31-38.

Table 2: Alterations between the grade of Oral Mucositis

 

RAL MUCOSITIS GRADE

 

 

 

 

 

 

0

II

III

IV

 

 

 

 

 

Cases (n)

2

4

9

8

 

 

 

 

 

Sex (n)

 

 

 

 

Male

2

0

7

3

Female

0

4

2

5

 

 

 

 

 

Previous chemotherapy (n)

 

 

 

 

Yes

2

1

7

6

No

0

3

2

2

 

 

 

 

 

Conditioning regimen (n)

 

 

 

 

TBI 1340+CFA

0

1

3

3

BUS 16+CFA

0

0

3

5

BUS12+CFA

1

1

2

0

RIC

1

0

1

0

Others

0

2

0

0

 

 

 

 

 

Oral Complains (%)

 

 

 

 

Dysphagia

0

100

100

100

Dysgeusia

50

33.3

88.9

75

Xerostomia

50

33.3

66.7

75

 

 

 

 

 

Days with oral pain (mean±SD)

0

10±3.1

14±4

19±3.4

 

 

 

 

 

Days with OM (mean±SD)

0

12±12.6

15±5.1

19±3.5

 

 

 

 

 

Opiods (mean±SD)

 

 

 

 

Maximum dose(mg/day/ IV)

3

25±10

40±12.6

71±6.1

Days of use

1

9±3.2

12±4.7

15±3.2

 

 

 

 

 

BMI (mean±SD) *

 

 

 

 

Initial

21.8±1.4

30±6.3

23.6±6.9

28.1±8.9

Final

21.9±1.5

28.3±5.6

22.1±6.1

25.5±7.4

Difference (Final – Initial)

0.13±0.1

- 1.4±0.9

- 2.3±1.2

- 3±1.5

 

 

 

 

 

Hospitalization time

39±19.8

36±7.5

36±4.4

37±4.6

(in days, mean±SD)

 

 

 

 

 

 

 

 

 

BMI= Body Mass Index; TBI 1320= Total Body Irradiation 1320 rads; CFA =

Cyclophosphamide 120 mg/Kg; BUS 12/16= Busulfan 12/16 Mg/Kg; Fin.=final;

In.=Initial * = p>0,05 ANOVA

of OM, pain level, dysphagia, dys- geusia and xerostomia were as- sessed daily. The examination started two days before the infu- sion of hematopoietic stem cells and ended twenty days later. At the first day, all patients received oral hygiene and OM care instruc- tions. The OM was classified ac- cording to the WHO scale13 and visual analog scale (VAS) was used to measure pain level. The partici- pants answered questions about dysphagia, dysgeusia and xerosto- mia. Clinical records were used to collect demographical data and to

verify hematological disease, med- ications, patient’s diet and Body Mass Index (BMI).

DATA ANALYSIS

Data were tabulated and organized using Software Statistical Pack- age for the Social Sciences (SPSS)

20.0.The Shapiro Wilk tests were used to verify the normality of the sample. Variance Analysis (ANOVA) and post hoc of Tukey were used to compare the BMI with maximum degree of OM. For statistic signifi- cant results was considered p <0.05.

RESULTS

The initial sample was composed of 25 participants, of whom two were excluded. One had septic shock and the other one refused to participate. The median age was 31 years old (min. 14- max. 55) and male adults were predominant in the sample (52%). The majority of individuals had malignant diseases (83%) and MA conditioning (91%). Sixty five percent of the partici- pants underwent chemotherapy prior the HSCT. Regarding the type of transplantation, 11 were related

ENERO - JUNIO 2019 ODONTOLOGÍA VITAL 33

Revista Odontología Vital Enero - Junio 2019. Año 17. Volumen 1, No. 30

donor (48%), the main source used was the bone marrow (83%) and the most common immunopro- phylaxis regimen was Ciclosporin + Methotrexate (Table 1).

The incidence of OM was 91% (Ta- ble 1). The median number of days with OM among individuals was 14 days (min. 0 – max. 26 days), while the median number of days with oral pain was 13 days (min. 0 – max. 25 days). On the other hand, the median OM grade, according to the WHO scale, was 3 (min. 0 – max. 4) and the maximum pain le- vel was 9 (min. 0 – max. 10). Opioid medication was used for 11 days (min. 0- max. 21) and maximum dose used was 42 mg / day / EV (min. 0- max. 80mg / day / EV). The result of these variables can be found on chart 1.

Based on the WHO scale, most of the participants had a maximum grade 3 (39%) of OM, individuals with this maximum degree of OM had mean of days of hospitaliza- tion similar to the mean of the other scores. Most individuals with grade 3 and 4 OM underwent che- motherapy prior to HSCT (Table 2). The individuals who had the highest number of days with oral pain were also those who reached the maximum score of OM (19 days), stayed more days with OM, used opioid medication for more days (mean of 15 days ± 3.2) with higher doses (mean maximum 71 mg / Day EV ± 6.1). (Table 2).

The conditioning that had the highest average number of individ- uals with grade 4 OM was Busulfan (BUS) 16 mg/kg + Cyclophospha- mide (CFA) 120mg/kg. (Table 2).

All individuals who had OM also had BMI reduction during the follow-up period. The mean loss of body mass from the beginning of hospitalization to the end was higher in individuals who reached

Table 3: Mean days with mucositis, pain and opioid medication

according to conditioning regimens.

Conditioning

TBI 1320

BUS 16+CFA

BUS12+CFA

OTHERS

 

+CFA

 

 

 

Days with OM

2

4

9

8

(mean+SD)

 

 

 

 

 

 

 

 

 

Days with mouth pain

 

 

 

 

(mean+SD)

2

0

7

3

 

0

4

2

5

Days of opioid use

12±3.4

15±3.8

5±3.7

9±6.3

(mean+SD)

 

 

 

 

 

 

 

 

 

Chart 1 Median of days with oral pain, oral mucositis (degree)

and opioid medication.

 

 

40

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36

 

 

 

 

 

 

 

 

 

 

 

 

 

 

35

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

32

31

 

 

 

32

 

 

 

 

 

 

 

 

 

 

30

 

 

 

 

 

 

 

 

 

 

 

 

30

30

 

 

30

30

 

 

 

 

 

 

 

 

 

Measurement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14

 

 

 

 

 

 

 

 

25

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20

 

 

 

 

 

 

 

 

 

 

 

20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

6

 

 

 

7

7

6

6

 

 

 

 

 

10

 

 

 

 

 

 

 

5

 

 

 

 

 

 

 

 

 

 

 

5

 

 

5

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

 

3

 

3

3

3

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

3

 

3

3

3

2

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

1

2

 

 

 

 

 

 

 

 

 

 

 

2

1

 

 

 

 

 

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

 

 

 

0

0

0

0

 

 

 

0

0

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

0

0

0

 

 

 

 

 

 

-2 -1

0

1 2

3

4

5

6

7

8

 

9

10 11 12 13 14 15 16 17 18 19 20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Days

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OM Degree

 

 

 

 

Opioid

 

 

 

 

Pain

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chart 2 Mean of Body Mass Index difference on each

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

oral mucositis grade

 

 

 

 

 

 

 

 

 

 

 

 

0.5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-0,5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Index

 

-1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-1,5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mass

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Body-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-2,5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-3,5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-4,5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

 

 

 

 

 

 

1

 

 

 

 

 

 

 

2

 

 

 

 

 

 

3

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oral Mucositis Grade

 

 

 

 

 

 

 

 

 

 

 

34 ODONTOLOGÍA VITAL ENERO - JUNIO 2019

Eurich, C., Pinheiro, C., Kanaan, S., Silva, G. M., Amenábar, J. M., Carvalho, C. (2019). Evaluación longitudinal de la mucositis oral en el trasplante de células madre hematopoyéticas: un estudio piloto. Odontología Vital 30:31-38.

Chart 3 Distribution of the different treatments used by

the patients for oral mucositis.

26%

52%

18%

 

 

4%

Chamomile tea

Chamomile tea + Benzidamine

Chamomile tea + Malvatricin + Benzidamine Chamomile tea + Low-Level laser

of the tissue damaged by chemo- therapeutic conditioning (Ahmed et al., 2017; Cutler et al., 2005; Knoll et al., 2016; Matsukawa et al., 2016; Ramírez-amador et al., 2010; Small et al., 2007).

When compared to the total of days of hospitlization, a significant average of days with OM, oral pain and opioid medication were dem- onstrated. This average changes when participants are segregated according to the maximum OM grade: Grade 4 individuals were affected with longer periods with OM, had more oral pain, more opi- oid using and with higher dosage than patients with lower scores.

There was a greater BMI loss in pa- tients who reached grade 3 and 4 OM, although no statistical signifi-

grade 4 OM. However, there was no statistical significance (p>0.05 ANOVA). On the other hand, the two patients without OM had an increase in BMI. (Chart 2)

The individuals who had the high- est mean number of days with OM and oral pain were those who had total body irradiation (TBI) 1320 rads + cyclophosphamide (CFA) 120 mg / kg as conditioning (Table 3).

In addition to the opioid, which all patients with OM received, the most used treatment for OM was low-level laser associated with chamomile tea (52%) (Chart 3). Topical treatments for OM were individualized according to the preferences and possibility of each subject, regarding the severity of OM, individual values, socioeco- nomic condition and above all the patient’s will.

DISCUSSION

The present study proposed to evaluate the incidence and degree of OM, and disorders related to it

in individuals submitted to allo- geneic HSCT. The most important findings were the high incidence OM and the correlation between the OM severity degree, according to WHO scale, with the use of opi- oid medication and BMI. Individu- als with higher OM scale values needed more opioid medication and lost more weight.

OM is a frequent condition in indi- viduals submitted to HSCT, which affects their quality of life (Silva et al., 2015; Vera-Llonch et al., 2007). In the present sample there were a great number of participants with leukemia, consequently, the con- ditioning regimens were mostly MA, which could explain the high incidence of OM (Eslami et al., 2016; Ramírez-amador et al., 2010; Small et al., 2007; Wojciechowicz et al., 2014).

The use of MTX as immunopro- phylaxis may also have been a contributing factor to OM high incidence due to its high cytotoxic potential in cells with rapid mul- tiplication. In addition, MTX is responsible for the delay of repair

cance was detected (Table2).

Regarding the conditioning regi- men, individuals who used BUS 16 or TBI 1320 had a higher degree of OM (Table 1). Although most of the participants with grade 3 and 4 OM used BUS 16, who had a longer mean of days with OM and mouth pain were those that conditioned with TBI 1320, which suggests that such conditioning leads to pro- longed toxicity. On the other hand, Chaudhry et al.(2016) performed a systematic review that evaluated the incidence and severity of OM in HSCT and found that there was a significant incidence of severe OM in both MA and RIC and those individuals who received TBI had more severe OM when compared to BUS. Nevertheless, it is impor- tant that individuals undergoing these types of conditioning receive extra oral.

Concerning the functional altera- tions in the mouth, there was a high incidence of dysgeusia and xerostomia in patients with grade 3 and 4 OM (Table 2). Boer (Boer et al., 2009) already evaluated the

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taste alteration of patients sub- mitted to HSCT and verified that the situation continues as a late complication. Furthermore, Laak- sonen et al.(Laaksonen et al., 2011) studied longitudinally the saliva of patients for 24 months after HSCT, and also demonstrated some func- tional alteration in the mouth, concluding that hyposalivation is frequent and occurs more in MA conditioning and is reversible.

It is important to note that the use of opioid medication may often be associated with other painful epi- sodes, not necessarily OM, so, it is important to evaluate other param- eters, such as evaluation of mouth pain by VAS and the score of OM by the scale of WHO. Moreover, BMI should be used judiciously, especially in individuals with lean mass and / or water retention. In future studies it is suggested that body composition should be con- sidered similarly to the study by Thomaz (ABESO, 2016; Thomaz et al., 2015).

One limitation of this study is the small number of participants. Fur- ther studies with higher sample size are suggested to evaluate the risk factors for OM and thus to de- lineate a line of care for this condi- tion.

Although OM is a self-limiting con- dition and resolves with decreas- ing of chemotherapy toxicity and consequent bone marrow regen-

eration, it is still a debilitating con- dition. Therefore, it is important to delimit its incidence, severity, risk factors and evolution time, for oral care can be implemented in the population at risk, in order to decrease the use of opioid medica- tion and its side effects, improving the quality of life of this group.

CONCLUSION

A high incidence of severe oral OM was observed in this population during this period of time. Indi- viduals with a maximum grade of OM 3 and 4 and greater dosages and longer time of opioid analge- sia use.

Authors

Carolina Eurich Mazur DDS1; Camila Pin- heiro Furquim DDS, MSc1; Samir Kanaan Nabhan MD2 ; Geisla Mary Silva Soares DDS, PhD 1; José Miguel Amenábar DDS, PhD1; Cassius Carvalho Torres-Pereira DDS, PhD1

1 Department of Stomatology, Gradu- ation Program in Dentistry. Federal University of Parana.

2 Bone Marrow Transplantation Unit, Hospital de Clínicas. Federal University of Parana

Author: Carolina Eurich Mazur

E-mail address: carolmazur6@hotmail. com

Cellphone number: +55 042 99291581

Address: Rua Doutor Corrêa Coelho – 744 – Edíficio Jardim Botânico, Jardim Botânico, Curitiba, Paraná, Brasil – CEP: 80210-350.

Brasil

36 ODONTOLOGÍA VITAL ENERO - JUNIO 2019

Eurich, C., Pinheiro, C., Kanaan, S., Silva, G. M., Amenábar, J. M., Carvalho, C. (2019). Evaluación longitudinal de la mucositis oral en el trasplante de células madre hematopoyéticas: un estudio piloto. Odontología Vital 30:31-38.

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