Evaluation of GVHD And oral mucositis in patients submitted to HSCT at the STMO-CHC of UFPR
DOI:
https://doi.org/10.5935/2525-5711.20230211Palavras-chave:
Hematopoietic Stem Cell Transplantation, Transplantation Conditionin, Graft versus Host Disease, Mucositis, MouthResumo
Oral graft-versus-host disease (GVHD) and oral mucositis (OM) are important complications of hematopoietic stem cell transplantation (HSCT) that significantly impact the patient's quality of life. In this context, this study aimed to evaluate the profile of patients undergoing allogeneic HSCT, assessing oral GVHD and OM occurrence. Data from medical records of patients that underwent HSCT between 2019 and 2021 were collected. Patients over 18 years old, with diseases or conditions requiring HSCT, were included. A clinical examination was performed to evaluate the occurrence of GVHD and OM. A total of 47 patients undergoing HSCT were evaluated of which 34.04% developed GVHD, and of these 81.25% have had oral involvement. As for OM, it affected 82.97% of the patients, with grades 3 and 4 being more detected. The most frequent previous disease was acute myeloid leukemia, and most of these patients received a related type of transplant (84.61%), fully compatible (53.84%), with bone marrow as a source of stem cells (53.84%). Most patients received the myeloablative conditioning regimen (69.23%). Cyclosporine was the most immunosuppressive agent used for the GVHD prevention associated with methotrexate (76.92%). Oral GVHD and OM are frequent and debilitating oral complications of HSCT, which can compromise a patient's general health and overall survival. Early diagnosis is important for a quick start of treatment and to reduce the impact on the patient's prognosis.
Referências
Ortega ETT, Kojo TK, Lima DH, Veran MP, Neves MI. Compêndio de enfermagem em transplante de células tronco hematopoéticas: rotinas e procedimentos em cuidados essenciais e em complicações. Curitiba: Editora Maio; 2004.
Haverman TM, Raber-Durlacher JE, Rademacher WMH, Vokurka S, Epstein JB, Huisman C, et al. Oral complications in hematopoietic stem cell recipients: the role of inflammation. Mediators Inflamm. 2014;2014:378281.
Ministério da Saúde (BR). Instituto Nacional de Câncer José Alencar Gomes da Silva. Tópicos em transplante de células-tronco hematopoéticas [Internet]. Rio de Janeiro: INCA; 2012; [access in 2022 Mar 05]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/topicos_transplante_celtronco_hematopoeticas.pdf
Ministério da Saúde (BR). Protocolo Clínico e Diretrizes Terapêuticas Imunossupressão pós transplante de Medula Óssea. Relatório de recomendação [Internet]. Brasília: Comissão Nacional de Incorporação de Tecnologias no SUS (CONITEC). 2016; [access in 2022 Mar 05]. Available from: http://conitec.gov.br/images/Consultas/Relatorios/2016/PCDT_Imunossupressao_TransplanteMedulaOssea_CP2016.pdf
Kuten-Shorrer M, Woo SB, Treister NS. Oral graft-versus-host disease. Dent Clin North Am. 2014 Apr;58(2):351-68.
Mays JW, Fassil H, Edwards DA, Pavletic SZ, Bassim CW. Oral chronic graft-versus-host disease: current pathogenesis, therapy, and research. Oral Dis. 2013 May;19(4):327-46.
Bassim CW, Fassil H, Mays JW, Edwards D, Baird K, Steinberg SM, et al. Oral disease profiles in chronic graft versus host disease. J Dent Res. 2015 Apr;94(4):547-54.
Bacigalupo A, Ballen K, Rizzo D, Giralt S, Lazarus H, Ho V, et al. Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transplant. 2009 Dec;15(12):1628-33.
Atilla E, Atilla PA, Demirer T. A review of myeloablative vs reduced intensity/non-myeloablative regimens in allogeneic hematopoietic stem cell transplantations. Balkan Med J. 2017 Jan;34(1):1-9.
Chaudhry HM, Bruce AJ, Wolf RC, Litzow MR, Hogan WJ, Patnaik MS, et al. The incidence and severity of oral mucositis among allogeneic hematopoietic stem cell transplantation patients: a systematic review. Biol Blood Marrow Transplant. 2016 Apr;22(4):605-16.
Legert KT, Ringdén O, Remberger M, Törlén J, Mattsson J, Dahllöf G. Oral mucositis after tacrolimus/sirolimus or cyclosporine/methotrexate as graft-versus-host disease prophylaxis. 2021 Jul;27(5):1217-25.
Çiftçiler R, Göker H, Demiroğlu H, Aladağ E, Aksu S, Haznedaroğlu IC, et al. Comparison of myeloablative versus reduced-intensity conditioning regimens for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia: a cohort study. Turk J Haematol. 2019 May;36(2):88-96.
Cutler C, Li S, Kim HT, Laglenne P, Szeto KC, Hoffmeister L, et al. Mucositis after allogeneic hematopoietic stem cell transplantation: a cohort study of methotrexate- and non-methotrexate-containing graft-versus-host disease prophylaxis regimens. Biol Blood Marrow Transplant. 2005 May;11(5):383-8.
Elad S, Aljitawi O, Zadik Y. Oral graft-versus-host disease: a pictorial review and a guide for dental practitioners. Int Dent J. 2021 Feb;71(1):9-20.
Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group Report. Biol Blood Marrow Transplant. 2015 Mar;21(3):389-401.e1.
Fall-Dickson JM, Pavletic SZ, Mays JW, Schubert MM. Oral complications of chronic graft-versus-host disease. J Natl Cancer Inst Monogr. 2019 Aug;2019(53):lgz007.
Mawardi H, Hashmi SK, Elad S, Aljurf M, Treister N. Chronic graft-versus-host disease: current management paradigm and future perspectives. Oral Dis. 2019 May;25(4):931-48.
Silva LCF, Martins CL, Tofani AA. Perfil de utilização de imunossupressores para profilaxia de doença enxerto versus hospedeiro em pacientes submetidos ao transplante de células-tronco hematopoiéticas. Rev Bras Cancerol. 2019 Apr/Jun;65(2):e-06148.
Redman MG, Harris K, Phillips BS. Low-level laser therapy for oral mucositis in children with cancer. Arch Dis Child. 2022 Feb;107(2):128-33.
Elad S. The MASCC/ISOO Mucositis Guidelines 2019: the second set of articles and future directions. Support Care Cancer. 2020;28(5):2445-7.
Daugėlaitė G, Uzkuraitytė K, Jagelavičienė E, Filipauskas A. Prevention and treatment of chemotherapy and radiotherapy induced oral mucositis. Medicina (Kaunas). 2019 Jan;55(2):25.
Cronshaw M, Parker S, Anagnostaki E, Mylona V, Lynch E, Grootveld M. Photobiomodulation and oral mucositis: a systematic review. Dent J (Basel). 2020 Aug;8(3):87.
Kusiak A, Jereczek-Fossa BA, Cichońska D, Alterio D. Oncological-therapy related oral mucositis as an interdisciplinary problem-literature review. Int J Environ Res Public Health. 2020 Apr;17(7):2464.
Zadik Y, Arany PR, Fregnani ER, Bossi P, Antunes HS, Bensadoun R, et al. Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2019 Oct;27(10):3969-83.
Valeh M, Kargar M, Mansouri A, Kamranzadeh H, Gholami K, Heidari K, et al. Factors affecting the incidence and severity of oral mucositis following hematopoietic stem cell transplantation. Int J Hematol Oncol Stem Cell Res. 2018 Apr;12(2):142-52.
Pavletic SZ, Vogelsang GB, Lee SJ. 2014 National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: preface to the series. Biol Blood Marrow Transplant. 2015;21(3):387-8.
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