Dissociations of oral foci of infections with infectious complications and survival after haematopoietic stem cell transplantation

Autoři: Matti Mauramo aff001;  Patricia Grolimund aff003;  Adrian Egli aff004;  Jakob Passweg aff006;  Jörg Halter aff006;  Tuomas Waltimo aff003
Působiště autorů: Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland aff001;  Department of Pathology, Haartman Institute and HUSLab, Helsinki University Central Hospital, Helsinki, Finland aff002;  Department for Oral Health & Medicine, UZB University Centre for Dental Medicine Basel, University of Basel, Basel, Switzerland aff003;  Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland aff004;  Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland aff005;  Department of Haematology, University Hospital Basel, Basel, Switzerland aff006
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0225099



Haematopoietic stem cell transplantation (HSCT) recipients are at increased risk for severe infections. This study examined the associations of common oral infections with survival and infectious complications in HSCT recipients.

Materials and methods

All autologous and allogeneic HSCT recipients transplanted in the University Hospital of Basel, Switzerland, between 2008 and 2016 and referred to oral infection control pre-HSCT were included in this retrospective case-control study. All patients had a clinical and a panoramic radiological dental examination taken immediately prior to HSCT. Presence of acute or chronic oral foci of infections, decayed, missing or filled tooth index (DMFT) and radiological attachment loss (RAL) were examined. Survival and infections of the subjects were followed up for 6 months post-HSCT.


Altogether 341 allogeneic and 125 autologous HSCT recipients were included in the study. Within 6 months post-HSCT, 47 (14%) of the allogeneic and 4 (3%) of the autologous recipients died. Oral foci of infections (acute or chronic), DMFT or periodontitis pre-HSCT were not associated with survival 6 months post-HSCT. Oral foci of infections were also not associated with hospital treated infectious diseases or blood culture positive bacteremia during the 6 month follow-up period. Untreated oral foci of infections were not associated with survival or severe infectious complications within 6 months post-HSCT.


The results of this study suggest that radical dental interventions to chronic oral infections could be postponed until post-HSCT.

Klíčová slova:

Bacteremia – Blood – Cancer treatment – Caries – Hematopoietic stem cell transplantation – Oral diseases – Periodontitis – Streptococcal infections


1. Appelbaum FR. Hematopoietic-Cell Transplantation at 50. N Engl J Med. 2007;357:1472–1475. doi: 10.1056/NEJMp078166 17928594

2. Gratwohl A, Pasquini MC, Aljurf M, Atsuta Y, Baldomero H, Foeken L, et al. One million haemopoietic stem-cell transplants: a retrospective observational study. Lancet Haematol. 2015;2:e91–100. doi: 10.1016/S2352-3026(15)00028-9 26687803

3. Bhatia S, Francisco L, Carter A, Sun CL, Baker KS, Gurney JG, et al. Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the Bone Marrow Transplant Survivor Study. Blood. 2007;110:3784–3792. doi: 10.1182/blood-2007-03-082933 17671231

4. Mohty B, Mohty M. Long-term complications and side effects after allogeneic hematopoietic stem cell transplantation: an update. Blood Cancer J. 2011;1:e16. doi: 10.1038/bcj.2011.14 22829137

5. Daikeler T, Mauramo M, Rovó A, Stern M, Halter J, Buser A. Sicca symptoms and their impact on quality of life among very long-term survivors after hematopoietic SCT. Bone Marrow Transplant. 2013;48:988–993. doi: 10.1038/bmt.2012.260 23292241

6. Brand HS, Bots CP, Raber-Durlacher JE. Xerostomia and chronic oral complications among patients treated with haematopoietic stem cell transplantation. Br Dent J. 2009;207:E17. doi: 10.1038/sj.bdj.2009.977 19893563

7. Laaksonen M, Ramseier AM, Rovó A, Jensen SB, Raber-Durlacher JE, Zitzmann NU, et al. Longitudinal assessment of hematopoietic stem cell transplantation and hyposalivation. J Dent Res. 2011;90:1177–1182. doi: 10.1177/0022034511414156 21734227

8. Castellarin P, Stevenson K, Biasotto M, Yuan A, Woo S, Treister NS. Extensive dental caries in patients with oral chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2012;18:1573–1579. doi: 10.1016/j.bbmt.2012.04.009 22516054

9. Hull KM, Kerridge I, Schifter M. Long-term oral complications of allogeneic haematopoietic SCT. Bone Marrow Transplant. 2012;47:265–270. doi: 10.1038/bmt.2011.63 21441960

10. Zimmermann C, Meurer MI, Grando LJ, Gonzaga Del Moral JÂ, da Silva Rath IB, Schaefer Tavares S. Dental treatment in patients with leukemia. J Oncol. 2015;2015:571739. doi: 10.1155/2015/571739 25784937

11. Mauramo M, Rohde L, Ramseier AM, Rovó A, Waltimo T. Determinants of stimulated salivary flow among haematopoietic stem cell transplantation recipients. Clin Oral Investig. 2017;21:121–126. doi: 10.1007/s00784-016-1760-0 26911494

12. Helenius-Hietala J, Meurman JH, Höckerstedt K, Lindqvist C, Isoniemi H. Effect of the aetiology and severity of liver disease on oral health and dental treatment prior to transplantation. Transpl Int. 2012;25:158–165. doi: 10.1111/j.1432-2277.2011.01381.x 22054477

13. Elad S, Raber-Durlacher JE, Brennan MT, Saunders DP, Mank AP, Zadik Y, et al. Basic oral care for hematology–oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer. 2015;23:223–236. doi: 10.1007/s00520-014-2378-x 25189149

14. Lazarchik DA, Filler SJ, Winkler MP. Dental evaluation in bone marrow transplantation. Gen Dent. 1995;43:369–371. 8940600

15. Elad S, Thierer T, Bitan M, Shapira MY, Meyerowitz C. A decision analysis: The dental management of patients prior to hematology cytotoxic therapy or hematopoietic stem cell transplantation. Oral Oncol. 2008;44:37–42. doi: 10.1016/j.oraloncology.2006.12.006 17307024

16. Schuurhuis JM, Stokman MA, Witjes MJ, Dijkstra PU, Vissink A, Spijkervet FK. Evidence supporting pre-radiation elimination of oral foci of infection in head and neck cancer patients to prevent oral sequelae. A systematic review. Oral Oncol. 2015;51:212–220. doi: 10.1016/j.oraloncology.2014.11.017 25524386

17. Schuurhuis JM, Span LFR, Stokman MA, van Winkelhoff AJ, Vissink A, Spijkervet FKL. Effect of leaving chronic oral foci untreated on infectious complications during intensive chemotherapy. Br J Cancer. 2016;114:972–978. doi: 10.1038/bjc.2016.60 27002936

18. Pepelassi EA, Diamanti-Kipioti A. Selection of the most accurate method of conventional radiography for the assessment of periodontal osseous destruction. Journal of clinical periodontology. 1997;24(8):557–567 doi: 10.1111/j.1600-051x.1997.tb00229.x 9266343

19. Cahn JY, Klein JP, Lee SJ, Milpied N, Blaise D, Antin JH, et al. Prospective evaluation of 2 acute graft-versus-host (GVHD) grading systems: a joint Société Française de Greffe de Moëlle et Thérapie Cellulaire (SFGM-TC), Dana Farber Cancer Institute (DFCI), and International Bone Marrow Transplant Registry (IBMTR) prospective study. Blood. 2005;106:1495–1500. doi: 10.1182/blood-2004-11-4557 15878974

20. Pasquini MC. Impact of graft-versus-host disease on survival. Best Pract Res Clin Haematol. 2008;21:193–204. doi: 10.1016/j.beha.2008.02.011 18503986

21. Walsh LJ. Clinical assessment and management of the oral environment in the oncology patient. Aust Dent J. 2010;55(Suppl 1):66–77.

22. Melkos AB, Massenkeil G, Arnold R, Reichart PA. Dental treatment prior to stem cell transplantation and its influence on the posttransplantation outcome. Clin Oral Investig. 2003;7:113–115. doi: 10.1007/s00784-003-0209-4 12768464

23. Kimura M, Araoka H, Yoshida A, Yamamoto H, Abe M, Okamoto Y, et al. Breakthrough viridans streptococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients receiving levofloxacin prophylaxis in a Japanese hospital. BMC Infect Dis. 2016;16:372. doi: 10.1186/s12879-016-1692-y 27495798

24. Mauramo M, Ramseier AM, Buser A, Tiercy JM, Weiger R, Waltimo T. Associations of HLA-A, -B and -DRB1 types with oral diseases in Swiss adults. PLoS One. 2014;9:e103527. doi: 10.1371/journal.pone.0103527 25072155

25. Busjan R, Hasenkamp J, Schmalz G, Haak R, Trümper L, Ziebolz D. Oral health status in adult patients with newly diagnosed acute leukemia. Clin Oral Investig. 2018;22:411–418. doi: 10.1007/s00784-017-2127-x 28536781

26. Durey K, Patterson H, Gordon K. Dental assessment prior to stem cell transplant: treatment need and barriers to care. Br Dent J. 2009;206:478–479.

27. Yamagata K, Onizawa K, Yanagawa T, Hasegawa Y, Kojima H, Nagasawa T, et al. A prospective study to evaluate a new dental management protocol before hematopoietic stem cell transplantation. Bone Marrow Transplant. 2006;38:237–242. doi: 10.1038/sj.bmt.1705429 16850033

28. Uutela P, Passweg J, Halter J, Weiger R, Waltimo T, Mauramo M. Common oral diseases in allogeneic haematopoietic stem cell transplantation (HSCT) recipients pre-HSCT. Eur J Haematol. 2019 Forthcoming. doi: 10.1111/ejh.13209 30632215

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2019 Číslo 12
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