title: TNF as marker of oral candidiasis, HSV infection, and mucositis onset during chemotherapy in leukemia patients.
abstract: OBJECTIVE
  To assess changes in the salivary expression of IL-1α, IL-1β, IL-2, IL-6, IL-10, IL-17, and TNF in acute leukemia (AL) patients before and during chemotherapy, and its association with HSV infection, oral candidiasis (OC), and oral mucositis (OM) onset.
  
  
  METHODS
  Cohort study in AL patients >15 years starting induction chemotherapy at a Mexican oncological center (2013-2014). Onset of oral lesions (OLs) was assessed during follow-up, and saliva was obtained at baseline, at visit 2 (days 4-12), and at visit 3 (days 13-21) after chemotherapy, treated with a protease inhibitor and stored at -70°C. An enzyme-linked immunosorbent assay was performed. Cox proportional hazards regression models were constructed to estimate hazard ratios and its 95% CI (HR, 95% CI) for OL development.
  
  
  RESULTS
  Forty-one patients were followed up, and 17 (41.5%) developed OLs. OL patients had higher baseline salivary IL-1α than those without lesions (p = 0.040). During visit 2, OL patients had higher levels of IL-1α (p = 0.033), IL-1β (p = 0.016), IL-6 (p = 0.035), and TNF (p = 0.019) than those who did not develop OLs. Patients with HSV infection, OC, and OM showed higher salivary TNF levels during follow-up (HR: 3.52, 95% CI: 1.35-9.14, p = 0.010).
  
  
  CONCLUSIONS
  AL patients undergoing chemotherapy with high salivary TNF levels were more likely to develop HSV infection, OC, and OM.
authors.affiliation: Master's Course in Oral Pathology and Oral Medicine, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, México.
authors.forename: V
authors.initials: V
authors.lastname: Ramírez-Amador
authors.affiliation: Master's Course in Oral Pathology and Oral Medicine, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, México.
authors.forename: J G
authors.initials: JG
authors.lastname: Zambrano
authors.affiliation: Master's Course in Oral Pathology and Oral Medicine, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, México.
authors.forename: G
authors.identifier: http://orcid.org/0000-0002-8881-867X
authors.initials: G
authors.lastname: Anaya-Saavedra
authors.affiliation: Biochemical Unit, Department of Genomic Medicine and Environmental Toxicology, Biomedical Research Institute, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Universidad Nacional Autónoma de México, Mexico City, México.
authors.forename: A
authors.initials: A
authors.lastname: Zentella-Dehesa
authors.affiliation: Master's Course in Oral Pathology and Oral Medicine, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, México.
authors.forename: E
authors.initials: E
authors.lastname: Irigoyen-Camacho
authors.affiliation: Liason Unit of the Faculty of Medicine, Instituto Nacional de Medicina Genómica, Universidad Nacional Autónoma de México, Mexico City, México.
authors.forename: N
authors.initials: N
authors.lastname: Meráz-Cruz
authors.affiliation: Clinical Epidemiology Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: S
authors.initials: S
authors.lastname: Ponce de León-Rosales
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D015415:Biomarkers / Q000378:metabolism; D002180:Candidiasis, Oral / Q000175:diagnosis / Q000378:metabolism*; D016207:Cytokines / Q000378:metabolism*; D004318:Doxycycline / Q000009:adverse effects; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis / Q000378:metabolism*; D006801:Humans; D007938:Leukemia / Q000188:drug therapy; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012463:Saliva / Q000378:metabolism*; D013280:Stomatitis / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D016207:Cytokines; D014409:Tumor Necrosis Factor-alpha; D004318:Doxycycline
keywords: acute leukemia; chemotherapy; inflammatory cytokines; oral lesions; oral mucositis; saliva