The need for endodontic treatment and systemic characteristics of hematopoietic stem cell transplantation patients

Abstract The aim of this study is to investigate the relationship between the epidemiological and clinical profiles of patients before and after hematopoietic stem cell transplantation (HSCT) and the need for endodontic treatment. The subjects included 188 individuals enrolled in the dental care program for transplanted patients of the School of Dentistry, Federal University of Minas Gerais (Faculdade de Odontologia da Universidade Federal de Minas Gerais, FO-UFMG) from March 2011 through March 2016. The patients were subjected to an HSCT conditioning dental regimen based on a thorough clinical and radiographic evaluation. Intraoral periapical and bite-wing X-rays were obtained, and after evaluation, specific dental treatment was planned and performed. The following demographic and clinical data were collected from the patients' medical records: age, gender, transplantation stage, primary disease, transplant type, medication used, complete blood count at the time of visit, and need for endodontic treatment. The Kolmogorov-Smirnov and the chi-square tests were used. Leukemia (31.3%) and multiple myeloma (17.9%) were the most prevalent primary diseases. Most patients were subjected to allogeneic-related transplantation (83.6%). Most patients exhibited platelet counts and hemoglobin concentrations below the reference values in the pre-transplantation stage, while the neutrophil and platelet counts and the hemoglobin levels were within the reference ranges in the post-transplantation stage. The proportions of individuals requiring endodontic treatment were similar between the pre- and post-transplantation groups: 24.3% and 24.7%, respectively. The systemic conditions of the patients referred for dental treatment were compromised.

Trasplante de células progenitoras hematopoyéticas en síndromes mielodisplásicos / Hematopoietic stem cell transplantation in the myelodisplastic syndromes

Myelodisplastic syndromes (MDS) are clonal hematopoietic disorders, characterized by ineffective hemopoiesis resulting in single or multiple lineages and a high risk of conversion to acute leukemia. Currently, the only established therapy with curative potential for MDS is a hemopoietic stem cell transplant (HSCT). Their results are determined by the type of MDS, age at the BMT and the score according to the international index. In the main studies the disease-free survival (DFS) were 35-43%, relapse 20 to 39% and transplantation-related mortality (TRM) 36-45%. HSCT offers best results in goods prognosis MDS (refractory anemia, refractory anemia with ring sideroblasts) with DFS of 53-72% and 13% of relapse, in contrast with the advanced MDS (refractory anemia with blast in excess (AREB), AREB in transformation and secondary acute leukemia) where the DFS is about ~ 33%, the relapse 23-34% and MRT 37-60%. The HSCT from unrelated donor is an option for patients that do not an HLA-matched related donor, with a ~ 30% of DFS, but with a MRT up to 58%. The HSCT with regimens of low intensity (minitransplants) for aged patients are feasible but their efficacy has not yet been determined.

Los síndromes mielodisplásicos (SMD) constituyen un grupo de enfermedades de las células progenitoras hematopoyéticas (CPH) caracterizadas por hematopoyesis ineficaz y una tendencia elevada a evolucionar a leucemia aguda. Hasta el momento actual el único tratamiento curativo lo representa el trasplante de CPH. Los resultados con esta terapia dependen de la variedad del SMD, de la edad de los pacientes al momento del trasplante y del índice pronóstico internacional. Los resultados de las principales series muestran una supervivencia libre de enfermedad (SLE) de 35-43%, con una recaída de 20 a 39% y una mortalidad asociada al trasplante (MRT) de 36 a 45%. Los mejores resultados se obtienen en SMD de buen pronóstico (anemia refractaria/anemia refractaria con sideroblastos en anillo) con SLE de 53-72% y una frecuencia de recaída de 13%, en contraste con los SMD avanzados (anemia refractaria con exceso de blastos ]AREB], AREB en transformación y leucemia aguda secundaria) en los que la SLE es de ~ 33%, la recaída de 23-34% y la MRT de 37-60%. El trasplante de CPH con donador vivo no relacionado es una opción para los pacientes que carecen de un donador familiar, con SLE de ~ 30% pero con una elevada MRT que llega a ser hasta de 58%. Los trasplantes con acondicionamiento de intensidad reducida (minitrasplantes) son factibles de realizar en pacientes de edad avanzada, aunque su eficacia está aún por determinarse.