180-day screening study for predicting the risk factors for developing acute oral Graft-versus-Host disease in paediatric patients subjected to allogenic haematopoietic stem cells transplantation.
OBJECTIVE
In this study, 58 paediatric patients were prospectively evaluated with a number of screening studies performed between 0 and 180 days after allogenic hematopoietic stem cells transplantation (HSTC) to detect any risk factors for developing oral manifestations of acute Graft-versus-Host Disease (a-GvHD).


METHODS
A total of 58 paediatric allogenic HSTC patients (37 males aged 1 to 15, and 21 females aged 4 to 18), entered the study and were observed by a trained dental team for a period of 6 months following transplantation while assuming cyclosporine, an immunosuppressive agent with a-GvHD prophylactic activity. Mean age at transplantation was 7.2 years old. Screening studies included physical examination, complete blood counts and liver function tests. Complete extraoral and intraoral clinical examinations were performed for all patients to detect oral lesions. Furthermore, some variables (sex, number of HSTC performed in the same patient, degree of HLA disparity and the positive/negative result of cytomegalovirus antigenemia test during the three months after engraftment) were investigated in the attempt to evaluate their predictive and/or diagnostic value in paediatric HSTC recipients. The resulting data were analysed with the Fisher's exact test.


RESULTS
Twenty-two percent of the patients developed oral manifestations of a-GvHD. Oral symptoms frequently are the major complaints of the patients during the follow-up period. The oral changes included mucositis, erosions and/or ulcerations; xerostomia, pain and bleeding were also referred. The variables investigated for predictive and/or diagnostic value in paediatric HSTC recipients included: sex (relative risk 0.494, 95% confidence interval 0.119-2.052, P=0.1242); number of HSTC performed in the same patient (relative risk 5.4, 95% confidence interval 0759-3.843; P=0.0714); degree of HLA disparity (relative risk 0.24, 95% confidence interval 0.058-0987, P=0.0428); and the result to cytomegalovirus (CMV) antigenemia test during the three months after engraftment (relative risk 0.86, 95% confidence interval 0.273-2.712, P=1).


CONCLUSIONS
Patients presenting two or more risk factors should be closely monitored for development of clinical oral a-GVHD, as oral complications are a significant cause of morbidity and potential mortality for children undergoing HSTC and can interfere significantly with transplant recovery.
Defabianis
P
P
Departement of Biomedical Sciences and Human Oncology, Section of Pedodontics, Traumatoloy and Oro-facial Malformations in the growing patients-University of Turin, Italy. patrizia.defabianis@unito.it
Braida
S
S
Guagnano
R
R
D000208:Acute Disease; D000293:Adolescent; D000956:Antigens, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006086:Graft vs Host Disease / Q000209:etiology* / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008297:Male; D009059:Mouth Diseases / Q000209:etiology* / Q000517:prevention & control; D006472:Oral Hemorrhage / Q000209:etiology; D019226:Oral Ulcer / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013280:Stomatitis / Q000209:etiology; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014987:Xerostomia / Q000209:etiology
D000956:Antigens, Viral; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D016572:Cyclosporine