Oral Changes in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Cohort Study

Abstract

Introduction: Hematopoietic stem cell transplantation (HSCT) is an important and potentially curative treatment for some hematological disorders. Chemotherapeutic preconditioning can result in complications due to the direct or indirect toxicities of the administered drugs. Among the adverse effects, various complications may arise within the oral environment. Objective: We investigated the occurrence of oral alterations in hematologic patients during their hospitalization for HSCT. Methods: This study involved 30 patients undergoing HSCT at a reference hospital in Brazil. Data on oral physical examination, hematological disorder diagnosis, transplant type, comorbidities, chemotherapy protocols, and oral risk factors were collected. Survival analysis was conducted to estimate the onset time of oral alterations and investigate potential associations with risk factors. Results: Oral alterations were observed in 93.3% of patients, with the most common being edema of the buccal mucosa (83.3%) and oral mucositis (80%). FluBuMel was the most frequently used conditioning protocol (46.7%). The mean follow-up time was 23 days, and the probability of the patient remaining free of oral alterations decreased as time progressed. The Mel200 protocol (HR 2.89; IC 0.04–1.02; p = 0.020) and autologous transplant (HR 3.41; CI 1.28–9.07; p = 0.004) were associated with an earlier occurrence of oral alterations, while allogenic related transplant was a protective factor (HR 0.48; CI 0.22–1.07; p = 0.040). Conclusion: The time of onset of oral alterations is affected by transplant type and conditioning protocol, and suggests that the severity of the alterations is positively influenced by the presence of dentists in the HSCT team.