Contributions
Abstract: PB2387
Type: Publication Only
Background
A link between oral cavity infections and chemotherapy-induced oral mucositis (CIOM) in patients with hematological malignancies (HMs) undergoing intensive chemotherapy (IC) or hematopoietic stem cell transplantation (HSCT) has been suggested. However, conclusive data are lacking, and there are no current guidelines for the prophylactic use of antimicrobials to prevent CIOM in these populations.
Aims
The aim of the current study was to prospectively determine the prevalence of HSV reactivation and colonization with Candida as well as the relationship between such oral microbial factors and CIOM development in patients with HM undergoing IC or HSCT.
Methods
Patients aged ≥19 years with HM undergoing IC or HSCT were enrolled. Each patient was evaluated for HSV and Candida in the oral cavity along with CIOM at baseline as well as the second, third, and fourth weeks. To evaluate the reactivation of HSV-1 and -2 in oral keratinocytes, a sample was obtained by placing a sterilized Transfer Membrane on the buccal mucosa. If CIOM developed, the sampling site included the CIOM lesions. DNA was isolated from the sampled membrane and reactivation of HSV-1 and -2 was determined by PCR using the HSV 1/2 PCR kit. At every evaluation (baseline, week 2, week 3, and week 4), CIOM presence was estimated and graded according to the WHO oral toxicity scale and the NCI-CTCAE), version 3.0. For the semiquantitative evaluation of the severity of CIOM, the reticulation, erythema, and ulceration (REU) scoring method for oral lichen planus or oral lichenoid lesions was applied.
Results
Seventy presentations among 56 patients were analyzed. CIOM was observed in 23 presentations (32.9%), with a higher incidence associated with HSCT (17 of 35 presentations, 48.6%) than with IC (6 of 35 presentations, 8.6%). Reactivation of HSV-1 was significantly associated with an increased incidence of CIOM and a higher 'reticulation, erythema, and ulceration' score after adjusting for age, sex, type of disease, and treatment stage. A higher HSV-1 viral load was associated with increased and more severe incidents of CIOM. The presence of Candida was not associated with CIOM.
Conclusion
HSV reactivation in the oral cavity is highly associated with CIOM in patients with HM undergoing high-dose chemotherapy, independent of age, sex, treatment stage, and type of disease. A prospective trial to evaluate the effect of prophylactic acyclovir on CIOM prevention in HM patients receiving induction chemotherapy or autologous HSCT is therefore warranted.
Session topic: 36. Quality of life, palliative care, ethics and health economics
Keyword(s): Hematological malignancy, Herpesvirus, Mucositis
Abstract: PB2387
Type: Publication Only
Background
A link between oral cavity infections and chemotherapy-induced oral mucositis (CIOM) in patients with hematological malignancies (HMs) undergoing intensive chemotherapy (IC) or hematopoietic stem cell transplantation (HSCT) has been suggested. However, conclusive data are lacking, and there are no current guidelines for the prophylactic use of antimicrobials to prevent CIOM in these populations.
Aims
The aim of the current study was to prospectively determine the prevalence of HSV reactivation and colonization with Candida as well as the relationship between such oral microbial factors and CIOM development in patients with HM undergoing IC or HSCT.
Methods
Patients aged ≥19 years with HM undergoing IC or HSCT were enrolled. Each patient was evaluated for HSV and Candida in the oral cavity along with CIOM at baseline as well as the second, third, and fourth weeks. To evaluate the reactivation of HSV-1 and -2 in oral keratinocytes, a sample was obtained by placing a sterilized Transfer Membrane on the buccal mucosa. If CIOM developed, the sampling site included the CIOM lesions. DNA was isolated from the sampled membrane and reactivation of HSV-1 and -2 was determined by PCR using the HSV 1/2 PCR kit. At every evaluation (baseline, week 2, week 3, and week 4), CIOM presence was estimated and graded according to the WHO oral toxicity scale and the NCI-CTCAE), version 3.0. For the semiquantitative evaluation of the severity of CIOM, the reticulation, erythema, and ulceration (REU) scoring method for oral lichen planus or oral lichenoid lesions was applied.
Results
Seventy presentations among 56 patients were analyzed. CIOM was observed in 23 presentations (32.9%), with a higher incidence associated with HSCT (17 of 35 presentations, 48.6%) than with IC (6 of 35 presentations, 8.6%). Reactivation of HSV-1 was significantly associated with an increased incidence of CIOM and a higher 'reticulation, erythema, and ulceration' score after adjusting for age, sex, type of disease, and treatment stage. A higher HSV-1 viral load was associated with increased and more severe incidents of CIOM. The presence of Candida was not associated with CIOM.
Conclusion
HSV reactivation in the oral cavity is highly associated with CIOM in patients with HM undergoing high-dose chemotherapy, independent of age, sex, treatment stage, and type of disease. A prospective trial to evaluate the effect of prophylactic acyclovir on CIOM prevention in HM patients receiving induction chemotherapy or autologous HSCT is therefore warranted.
Session topic: 36. Quality of life, palliative care, ethics and health economics
Keyword(s): Hematological malignancy, Herpesvirus, Mucositis