title: Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia.
abstract: BACKGROUND
  Odontogenic diseases can be a risk factor for life-threatening infection in patients with hematologic malignancies during chemotherapy that induces myelosuppression of variable severity. Previous studies noted the necessity of the elimination of all odontogenic foci before hematopoietic stem cell transplantation. To enable planning for the adequate dental intervention, the oral medicine team must understand the general status of patient and the intensity of the chemotherapy, which is sometimes difficult to be fully appreciated by dental staff. Therefore, a simplified grading would facilitate the sharing of information between hematologists, dentists and oral hygienists. This study aimed to introduce our myelosuppression grading of chemotherapies for hematologic malignancies and analyze the timing of occurrence of severe odontogenic infection.
  
  
  METHODS
  37 patients having received various chemotherapies for hematologic malignancies were enrolled. The chemotherapy regimens were classified into four grades based on the persistency of myelosuppression induced by chemotherapy. Mild myelosuppressive chemotherapies were classified as grade A, moderate ones as grade B, severe ones as grade C, and chemotherapies that caused severe myelosuppression and persistent immunodeficiency (known as conditioning regimens for transplant) as grade D. The timing of occurrence of severe odontogenic infection was retrospectively investigated.
  
  
  RESULTS
  Two patients (5.4%) had severe odontogenic infections after grade B or C chemotherapy. One occurred after extraction of non-salvageable teeth; the other resulted from advanced periodontitis in a tooth that could not be extracted because of thrombocytopenia. Both were de novo hematologic malignancy patients. During grade D chemotherapy, no patients had severe odontogenic infections.
  
  
  CONCLUSIONS
  The simplified grading introduced in this study is considered a useful tool for understanding the myelosuppressive state caused by chemotherapy and facilitating communication between medical and dental staff. During the period around the primary chemotherapy, especially for de novo hematologic malignancy patients who often received grade B to C myelosuppression chemotherapy, caution should be exercised for severe odontogenic infection by the oral medicine team, irrespective of whether invasive treatment is to be performed.
authors: Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. akashim@med.kobe-u.ac.jp
authors: Masaya
authors: M
authors: Akashi
authors: Yasuyuki
authors: Y
authors: Shibuya
authors: Junya
authors: J
authors: Kusumoto
authors: Shungo
authors: S
authors: Furudoi
authors: Yumiko
authors: Y
authors: Inui
authors: Kimikazu
authors: K
authors: Yakushijin
authors: Atsuo
authors: A
authors: Okamura
authors: Hiroshi
authors: H
authors: Matsuoka
authors: Takahide
authors: T
authors: Komori
mesh_terms: D000328:Adult; D000368:Aged; D003797:Dental Staff; D005260:Female; D005491:Focal Infection, Dental; D019337:Hematologic Neoplasms / Q000188:drug therapy*; D006801:Humans; D007165:Immunosuppression Therapy / Q000145:classification; D033183:Interdisciplinary Communication; D008297:Male; D008503:Medical Staff; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000145:classification*; D009190:Myelodysplastic Syndromes / Q000139:chemically induced* / Q000145:classification; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D019172:Transplantation Conditioning / Q000379:methods; D055815:Young Adult
chemical_list: D019653:Myeloablative Agonists
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