Abstract
The aim of the present study was to analyze the relationship of OM with possible risk factors such as oral health condition, immunological status and IL-1β profile in patients submitted to hematopoietic stem cell transplantation (HSCT). Fifty-four individuals submitted to HSCT were included. All patients received previous dental treatment and photobiomodulation (PBM) as the institutional OM preventive protocol. OM scores, immune status, and IL-1β levels were determined during the conditioning period and at D+3 and D+8 after HSC infusion. IL-1β gene polymorphism was also analyzed during conditioning. Possible associations of OM with risk factors were analyzed using conditional Fisher's exact test. OM was observed in 34 patients (62.9%) classified as Grade 1 (13 patients/24.1%), Grade 2 (14 patients/25.9%), Grade 3 (3 patients/5.5%), and Grade 4 (4 patients/7.4%). Allogeneic HSCT individuals exhibited a higher OM grade than autologous subjects. Moreover, an association was observed between severe OM and severe gingivitis (p = 0.01), neutropenia (p = 0.03), and leukopenia (p = 0.04). A significant association between OM and lower IL-1β levels was detected at three time points, i.e., conditioning (p = 0.048), D+3 (p = 0.01), and D+8 (p = 0.005). The results showed that IL-1β gene polymorphism was not associated with OM. Our study provided important insights into the scope of OM risk factors in the setting of HSCT. Patients submitted to HSCT with severe gingivitis prior to chemotherapy and with severe neutropenia and leukopenia exhibited a higher OM grade. Further investigation will be necessary to better understand the exact role of IL-1β in the context of OM pathobiology and to validate cytokine analysis in larger cohorts.
Highlights
Submitted: January 25, 2021 Accepted for publication: July 13, 2021 Last revision: August 10, 2021Oral mucositis (OM) represents one of the most common and painful effects of hematopoietic stem cell transplantation (HSCT).[1,2] Almost 70% of individuals receiving HSCT develop this condition, characterized by an inflammatory reaction clinically exhibiting erythematous and/orBraz
The expression rate of some proteins included in the inflammation response, such as IL-1β, is partially associated with the OM process, the presence of these proteins does not exclude others mucositis-independent inflammation events
Study population Fifty-four consecutive patients who were admitted to the Porto Alegre Clinical Hospital (HCPA) for HSCT were enrolled in the study between June 2012 and October 2013
Summary
Submitted: January 25, 2021 Accepted for publication: July 13, 2021 Last revision: August 10, 2021Oral mucositis (OM) represents one of the most common and painful effects of hematopoietic stem cell transplantation (HSCT).[1,2] Almost 70% of individuals receiving HSCT develop this condition, characterized by an inflammatory reaction clinically exhibiting erythematous and/orBraz. Direct mechanisms include mucosal injury caused by radiotherapy and chemotherapy, while indirect damage results from the release of therapy-induced neutropenia and oral microbiome and environment modification.[6] the expression rate of some proteins included in the inflammation response, such as IL-1β, is partially associated with the OM process, the presence of these proteins does not exclude others mucositis-independent inflammation events This strongly implies the need to find biomarkers that characterize the development of the mucositis process.[7] several aspects of OM development have been defined, accumulating data have demonstrated that this process is more complex than originally described
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