Análise do desenvolvimento de alterações bucais em pacientes sob transplante de células-tronco hematopoiéticas e seus fatores de risco: um estudo de coorte / Analysis of the development of oral changes in patients undergoing hematopoietic stem cell transplantation and their risk factors: a cohort study

O transplante de células-tronco hematoiéticas (TCTH) pode causar efeitos adversos no meio ambiente bucal, podendo influenciar a resposta do paciente ao tratamento e, consequentemente, no prognóstico. Este estudo objetivou identificar as alterações bucais mais prevalentes durante o período de internação para a realização do TCTH, analisar o tempo de desenvolvimento destas alterações neste mesmo período, bem como os fatores inerentes ao paciente e ao TCTH associados ao desenvolvimento destas alterações. Tratou-se de um estudo observacional, longitudinal, do tipo coorte, realizado em 30 pacientes assistidos pelo setor de transplante de medula óssea em um hospital de referência no Rio Grande do entre dezembro de 2021 a junho de 2022. Os dados sobre o exame físico bucal, diagnóstico da desordem hematológica, o tipo de transplante, as comorbidades, os protocolos quimioterápicos e os fatores de risco individuais dos pacientes no período do TCTH obtidos foram submetidos a testes estatísticos para estimar o tempo de surgimento das alterações e associação de fatores de risco. A significância estatística adotada foi de 5%. Dos 30 pacientes selecionados, 56,7% eram do sexo masculino, mediana de 35 anos, no qual 93,3% desenvolveram alguma alteração bucal e 53,3% iniciaram o tratamento com algum fator de risco bucal. As desordens hematológicas mais frequentes foram as leucemias (mieloide e linfoide) e os mielomas múltiplos (23,3% cada). O FluBuMel foi o protocolo de condicionamento mais utilizado (46,7%). A alteração bucal mais frequente foi o edema de mucosa jugal (83,3%) seguida da mucosite oral (80%; grau 01 - 54,2%). O tempo de seguimento foi em média 23 dias e, foi verificado que no 5.º dia de internação a probabilidade do paciente estar livre de alterações bucais foi de 93,3%, com essa taxa diminuindo ao longo do tempo, atingindo 6,7% no 28.º dia. O protocolo Mel200 foi associado ao desenvolvimento mais precoce das alterações bucais (p=0,02), assim como o transplante do tipo autólogo (p=0,004). Nossos resultados sugerem que o tempo de surgimento das alterações bucais é influenciado pelo tipo de transplante e protocolo de condicionamento quimioterápico e, adicionalmente, reforçam que a presença de um cirurgiã-dentista na equipe influencia positivamente no controle da severidade das alterações bucais (AU).

Hematopoietic stem cell transplantation (HSCT) can cause adverse effects in the oral environment that can affect the patient's response to treatment and prognosis. Thereby, this study aimed to identify the most prevalent oral alterations during the period of hospitalization for the performance of HSCT, to analyze the development time of these alterations in this period, as well as the factors associated with the development of these alterations. It was an observational, longitudinal, cohort study, carried out on patients assisted by the bone marrow transplant sector in a main hospital in Rio Grande do Norte between December 2021 and June 2022. Data about oral physical examination, diagnosis of hematological disorder, type of transplant, comorbidities, chemotherapy protocols and oral risk factors of patients obtained during the HSCT period were submitted to statistics tests to estimate the time of oral changes' onset and association of risk factors. The statistical significance adopted was 5%. 57.7% of the 30 selected patients were male, with a median age of 35 years, where 93.3% developed some oral alteration and 53.3% started treatment with some individual risk factor. The most frequent neoplasms were leukemias (myeloid and lymphoid) and multiple myeloma (23.3% each). FluBuMel was the most commonly used conditioning protocol (46.7%). The most frequent oral alteration was buccal mucosa edema (83.3%) followed by oral mucositis (80%; grade 1­54.2%). The follow-up time was on average 23 days and it was found that on the 5th day of hospitalization, the probability of the patient being free of alterations was 93.3%, with this rate decreasing over time, reaching 6.7% on the 28th day. The Mel200 protocol is associated with earlier development of alterations (p=0.02), as well as autologous transplantation (p=0.004). The results suggest that the time of onset oral alterations is affected by the type of transplant and chemotherapy conditioning protocol and, additionally, reinforce that the alterations' severity are positively affected by the presence of a dentist in the team (AU).

Estudo da infiltração de tecidos orais em pacientes com doenças hematológicas malignas / Study of oral infiltration in patients with malignant haematological diseases

Este trabalho realizou um estudo retrospectivo dos prontuários do Hospital das Clínicas (HC) da Universidade Federal de Minas Gerais (UFMG). Foram incluídos os indivíduos admitidos no período de 2010 a 2021 com diagnóstico de leucemia/linfoma e que foram avaliados pela equipe do Serviço de Odontologia do HC­UFMG. Foram coletados dados demográficos, características clínicas da doença de base e da cavidade bucal e presença de infiltração oral maligna. O teste t não pareado foi utilizado para avaliar os hemogramas e o teste McNemar para comparar indivíduos que desenvolveram infiltração oral maligna e aqueles que não desenvolveram. A significância estatística foi estabelecida como p<0,05. Adicionalmente, uma revisão da literatura de relatos de casos e séries de casos foi realizada em quatro bases de dados eletrônicas (PubMed, Web of Science, Scopus e Embase). Dos 781 prontuários analisados, a leucemia linfocítica aguda (30,1%) foi o diagnóstico mais frequente. Pacientes nas duas primeiras décadas de vida foram mais acometidos pela doença de base. Cárie (36,7%) e alterações periodontais (34,6%) foram as condições bucais mais observadas. Infiltração oral maligna ocorreu em 25 (3,2%) indivíduos, envolvendo principalmente a gengiva (80%) e indivíduos diagnosticados com leucemia mieloide aguda (64%). Comparando os dados de pacientes pediátricos que desenvolveram infiltração maligna e aqueles que não desenvolveram, a proporção de óbitos foi maior naqueles que tiveram infiltração (p=0,002), enquanto em adultos, aqueles que desenvolveram infiltração exibiram pior condição periodontal e maior proporção de óbitos (p<0,001). Dados da revisão da literatura demonstraram que a infiltração oral maligna foi mais frequente na gengiva (37%) e em pacientes com leucemia mieloide aguda (47%). As principais características clínicas e de imagem associadas à infiltração oral foram aumento de volume e lesões osteolíticas. Em conjunto, os dados sugerem a importância do monitoramento clínico odontológico de pacientes com leucemia/linfoma considerando os piores desfechos clínicos relacionados à infiltração dos tecidos orais.

This work carried out a retrospective study of the medical records at the Hospital das Clínicas (HC), Universidade Federal de Minas Gerais (UFMG). Individuals admitted in the period from 2010 to 2021 with a diagnosis of leukaemia/lymphoma and who were evaluated by the team of the dental service of HC­UFMG were included. Demographic data, clinical characteristics of the underlying disease and oral cavity, and presence of malignant oral infiltration were collected. The unpaired t test was employed to assess the blood count and the McNemar test to compare individuals who developed malignant oral infiltration and those who did not. Statistical significance was set at p<0.05. Additionally, a literature review of case reports and case series was undertaken in four electronic databases (PubMed, Web of Science, Scopus, and Embase). Of the 781 medical records analysed, acute lymphocytic leukaemia (30.1%) was the most frequent diagnosis. Patients in the first two decades of life were more affected by the underlying disease. Caries (36.7%) and periodontal changes (34.6%) were the most frequently observed oral conditions. Oral malignant infiltration took place in 25 (3.2%) individuals, mainly involving the gingiva (80%) and individuals diagnosed with acute myeloid leukaemia (64%). Comparing data from paediatric patients who developed malignant infiltration and those who did not, the proportion of deaths was higher in those who had infiltration (p=0.002), while in adults, those who developed infiltration had worse periodontal status and a higher proportion of death (p<0.001). Data from the literature review showed that oral malignant infiltration was more frequent in the gingiva (37%) and in patients with acute myeloid leukaemia (47%). The main clinical and imaging features associated with oral infiltration were swelling and osteolytic lesions. Altogether, the data suggest the importance of clinical dental monitoring of patients with leukaemia/lymphoma considering the worst clinical outcomes related to oral tissue infiltration.

Geographic Distribution of Childhood Cancer in Brazil and the Time between the Diagnosis and the Start of Treatment: An Analysis of Hospital-Based Cancer Registries, 2010-2016

Abstract Objective: To analyze the distribution of childhood cancer in Brazil and the time between the diagnosis and the start of treatment, according to hospital-based cancer registries (2010-2016). Material and Methods: This was an observational descriptive study using secondary data (36,187 records) from hospital databases of the National Cancer Institute (INCA) and the Onco-center Foundation of São Paulo (FOSP). Epidemiological data were obtained, and compliance with Federal Law 12,732/12 was verified, which establishes a maximum period of 60 days to start cancer therapy after the diagnosis. Absolute and percent frequencies, central tendency and dispersion measures, and the coefficient of prevalence of childhood cancer were calculated. Results: The mean age of the pediatric patients was 9.3 years (± 6.2); 54.1% (n=19,586) of them were males; 32.0% (n=11,440) were aged 0 to 4 years; and 43.4% (n=11,338) had a self-reported mixed-race skin color. The Southeast region of Brazil accounted for 40.2% (n=14,564) of the cases, of which 63.0% (n=9,178) corresponded to solid neoplasms, as opposed to the North region, where hematological neoplasms prevailed (53.9%, n=1,535). Most registered patients aged 0 to 19 years were treated in 60 days or less (77%, n=27,929). However, for 24.0% (n = 2,207) of adolescents (15 to 19 years) this time was more than 60 days after the diagnosis. Conclusion: The characteristics related to childhood cancer varied across the Brazilian geographic regions, and most patients were properly treated within the time enforced by law.

Differences between the oral changes presented by patients with solid and hematologic tumors during the chemotherapeutic treatment

Abstract Objective: This study sought to identify the differences between the oral changes presented by patients with solid and hematologic tumors during chemotherapeutic treatment. Methodology: This is an observational, prospective and quantitative study using direct documentation by follow-up of 105 patients from 0 to 18 years using the modified Oral Assessment Guide (OAG). Of the 105 patients analyzed, 57 (54.3%) were boys with 7.3 years (±5.2) mean age. Hematologic neoplasms accounted for 51.4% of all cases. Results: Voice, lips, tongue, and saliva changes were not significantly different (p>0.05) between patients with solid or hematologic tumors and during the follow-up. From the 6th until the 10th week of chemotherapeutic treatment alterations in swallowing function, in the mucous membrane (buccal mucosa and palate), in the labial mucosa, and in the gingiva occurred and were distributed differently between the two tumors groups (p<0.05). The main alterations were observed in patients with hematologic tumors. Conclusion: It was concluded that the oral changes during the chemotherapeutic treatment occurred especially in swallowing function, in the mucous membrane, in the labial mucosa and in the gingiva, and these alterations were found mainly in patients with hematologic tumors.

Análise sociodemográfica e clínica de pacientes submetidos ao transplante alogênico de células-troncos hematopoiéticas / Sociodemographic and clinical analysis of patients subjected to allogeneic hematopoietic stem cell transplantation

Objetivo: Descrever os achados clínicos e sociodemográficos dos pacientes submetidos ao transplante de células-tronco hematopoiéticas (TCTH) e encaminhados à Faculdade de Odontologia da Universidade Federal de Minas Gerais (FO-UFMG). Metodologia: Foram selecionados 39 pacientes pré-TCTH alogênico entre 2006 e 2008. Os dados sociodemográficos e clínicos foram obtidos dos prontuários médicos do dia - 7 ao dia +360 pós-TCTH. Resultados: Foi possível observar que 59% dos pacientes eram homens, 25,6% eram melanoderma e 53,8% eram solteiros. Trinta e três por cento deles possuíam o ensino fundamental, 38,5% eram católicos e 56,4% residiam em casa, sendo que (51,2%) residem em casa própria e, (61,5%) em zona urbana. O saneamento básico estava presente em 64,1%, a coleta seletiva em 69,2% e a água encanada em 64,1%. A medula óssea foi a fonte de células-tronco para o TCTH usada em 61,5% dos casos, a doença de base mais prevalente foi a leucemia (46,4%) e 41% dos pacientes foram a óbito após o TCTH. Além disso, 43,6% dos pacientes apresentaram a doença do enxerto contra o hospedeiro aguda (DECHa) e 62,5% DECHc sistêmica e 58,3% DECHc bucal. Conclusão: Assim, este estudo adiciona ao conhecimento no contexto do TCTH dados referentes ao perfil clínico e sociodemográfico dos pacientes e com isso, sugere que o êxito do transplante compreende na sinergia de todos os aspectos referentes ao transplantado.

Objective: To describe the clinical and sociodemographic findings of the patients subjected to hematopoietic stem cell transplantation (HSCT) and referred to the School of Dentistry of the Federal University of Minas Gerais (FO-UFMG). Method: Thirty-nine pre-allogeneic HSCT patients were selected between 2006 and 2008. The clinical and sociodemographic data were obtained from the medical charts from day -7 to day +360 post-HSCT. Results: It was found that 59% of the patients were male, 25.6% were Black and 53.8% were single. Thirty-three percent of them completed the elementary school, 38.5% were Catholic and 56.4% lived at home; of these, 51.2% owned their houses and 61.5% lived in the urban area. As much as 64.1%, 69.2%, 64.1% of the patients had access to basic sanitation, selective collection of residues and water supply pipelines. The bone marrow was the source of stem cells for the HSCT used in 61.5% of the cases, leukemia was the most prevalent base disease (46.4%), and 41% of the patients died after HSCT. Additionally, 43.6% of the patients presented acute graft-versus-host disease (GVHD), 62.5% presented chronic systemic GVHD, and 58.3% presented oral GVHD. Conclusion: This study adds to the knowledge of HSCT information about the clinical and sociodemographic profile of the patients, suggesting that the success of transplantation encompasses the synergy of all aspects associated with the transplant recipient.