Abstract

Febrile neutropenia (FN) is an infectious complication that develops during chemotherapy. Although the oral cavity can be an important infection route, it is unknown whether the oral environment is associated with FN. The present study examined the relationship between the oral environment using periodontal inflamed surface area (PISA), a new periodontal disease parameter, and FN in hematologic cancer patients undergoing chemotherapy. In this retrospective cohort study, 157 patients were divided into FN onset during chemotherapy (n = 75) and the FN negative groups (n = 82). The associations of risk factors related to the intraoral environment were assessed. Logistic regression analysis showed that types of blood cancer (odds ratio 1.98; P < 0.01), use of a high-risk regimen (odds ratio 4.44; P < 0.05), prophylaxis treatment with human granulocyte colony-stimulating factor (G-CSF) (odds ratio 4.15; P < 0.01) and PISA (odds ratio 1.02; P < 0.01) were independent factors associated with FN onset. Finally, propensity score matching was performed between two groups; 37 matched pairs were generated. PISA was significantly higher in the FN group than the FN negative group. There was a significant relationship between PISA and FN onset (P = 0.035). The present findings indicate that periodontitis treatment before starting cancer treatment is recommended as supportive care for preventing FN onset during chemotherapy.

Highlights

  • Febrile neutropenia (FN) is an infectious complication that develops during chemotherapy

  • Clinical parameter Age, years Gender, male/female body mass index (BMI), kg/m2 Smoking status, n (%) No Former Current Alcohol status, n (%) No Occasionally Daily Hypertension, n (%) Diabetes mellitus, n (%) Hyperlipidemia, n (%) Previous episode of malignant tumor Performance status, median (IQR) Types of blood cancer, n (%) Malignant lymphoma Leukemia/myelodysplastic syndrome Multiple myeloma Others Febrile neutropenia onset, n (%) High-risk regimen, n (%) granulocyte colony-stimulating factor (G-CSF) use as primary FN prophylaxis n = 157 62.3 ± 14.8 81/76 21.6 ± 3.7

  • Parameter Age, years Gender, male/female BMI, kg/m2 Smoking status, n (%) No Former Current Alcohol status, n (%) No Occasionally Daily Hypertension, n (%) Diabetes mellitus, n (%) Hyperlipidemia, n (%) Previous episode of malignant tumor Performance status, 0–1/2–4 Types of blood cancer, n (%) Malignant lymphoma Leukemia/myelodysplastic syndrome Multiple myeloma Others High-risk regimen, n (%) G-CSF use as primary FN prophylaxis, n (%) Remaining teeth Probing depth, mm, n (%) < 4 ≥ 4 and < 6 ≥ 6 bleeding on probing (BOP), n (%) Periodontal epithelial surface area (PESA): periodontal epithelial surface area PISA: periodontal inflamed surface area

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Summary

Introduction

Febrile neutropenia (FN) is an infectious complication that develops during chemotherapy. The present study examined the relationship between the oral environment using periodontal inflamed surface area (PISA), a new periodontal disease parameter, and FN in hematologic cancer patients undergoing chemotherapy. In this retrospective cohort study, 157 patients were divided into FN onset during chemotherapy (n = 75) and the FN negative groups (n = 82). Cancer patients undergoing chemotherapy can be affected by various complications, with one of the major adverse effects known to be myelosuppression, resulting in such conditions as neutropenia, infectious disease, and gastrointestinal symptoms including nausea, vomiting, diarrhea, and oral ­mucositis[1]. Nesse et al showed a dose–response relationship between PISA and HbA1c in patients with type 2 d­ iabetics[12], suggesting that PISA may be an indicator for examining the relationship between periodontal disease and FN

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