Oral graft vs host disease: An immune system disorder in hematopoietic cell transplantation

Oral graft vs host disease: An immune system disorder in hematopoietic cell transplantation

World J Stomatol. May 20, 2015; 4(2): 96-102
Published online May 20, 2015. doi: 10.5321/wjs.v4.i2.96

Paulo Sérgio da Silva Santos, Cassia Maria Fischer Rubira, Héliton Spíndola Antunes, Fabio Luiz Coracin, Cristiane Miranda França

Graft vs host disease (GVHD) is a complication of patients who are treated by hematopoietic cell transplantation. National Institutes of Health in 2005 by Working Group on Diagnosis and Staging Consensus Development Project on Criteria for Clinical Trials in Chronic GVHD (cGVHD) established 2 principal categories of oral GVHD, acute and chronic. The oral mucosa may be the first site of manifestation of the disease. Clinical diagnosis needs to be confirmed by a biopsy of oral mucosa and minor salivary glands. Microscopic results have played a major role in the diagnosis and management of acute and chronic oral GVHD. Development of second malignancies is the greatest risk of oral cGVHD patients, mostly regarding squamous cell carcinoma. The focus of oral GVHD therapy is to improve symptoms and maintain oral function. The aim of this review article is to update the information on the oral GVHD in its clinical, microscopic features and their complications.

acesso ao artigo: http://www.wjgnet.com/2218-6263/abstract/v4/i2/96.htm

17° Simpósio de Odontologia em Hematologia

Luiz Alberto Valente soares Jr. - coordenador/coordinator 8:30 - 8:45 Luiz Alberto Valente Soares Jr. Abertura/Opening Políticas públicas: a participação dos cirurgiões dentistas nas associações médicas: experiências e valores agregados à classe odontológica/Public policies: participation of dental surgeon in medical associations: experience and principles added to the dental profession Luiz antônio de Souza - moderador/moderator 8:45 - 9:05 Marco Antonio Manfredini Palestrante/Speaker 9:05 - 9:15 Discussão/Discussion Educação / Ensino: experiências bem sucedidas do ensino na área de pacientes com necessidades especiais (oncologia/hematologia) na odontologia/Education: successful experiences in the dentistry teaching for patients with special needs (oncology/hematology) Luiz Alberto Valente soares Jr. - moderador/moderator 9:15 - 9:35 Carina Domaneschi Palestrante/Speaker 9:35 - 9:55 Karin Sá Fernandes Palestrante/Speaker Abordagem odontológica ambulatorial ao paciente hemofílico: novo panorama do uso fator nas profilaxias/ Outpatient dental approach to hemophilia patients: new scenario of the use of factor in prophylaxis célia Maria Bolognese Ferreira - moderador/moderator 9:55 - 10:15 Paula Ribeiro Villaça Palestrante/Speaker 10:15 - 10:35 Eduardo Lima Pádua Palestrante/Speaker 10:35 - 10:55 Discussão/Discussion 10:55 - 11:10 Intervalo/Break Geisa Badauy Lauria silva - moderador/moderator 11:10 - 11:30 Luis Carlos Marques Fitoterapia na cavidade oral/Phytotherapy in oral cavity 11:30 - 11:50 Fábio Coracin Efeitos da quimioterapia sobre as glândulas salivares/Effects of chemotherapy on salivary glands 11:50 - 12:10 José Tadeu Tesseroli de Siqueira Manejo da dor orofacial no paciente onco-hematológico/ Orofacial pain management in onco-hematological patient 12:10 - 12:30 Discussão/Discussion

http://hemo.org.br/?page_id=32

A SYSTEMATIC REVIEW OF THE LONG-TERM EFFECTS OF DENTAL DEVELOPMENT DISTURBANCES AFTER HEMATOPOIETIC STEM-CELL TRANSPLANTATION IN PEDIATRIC PATIENTS

A SYSTEMATIC REVIEW OF THE LONG-TERM EFFECTS OF DENTAL DEVELOPMENT DISTURBANCES AFTER HEMATOPOIETIC STEM-CELL TRANSPLANTATION IN PEDIATRIC PATIENTS

Alexandre Viana Frascino, Fábio Luiz Coracin, Paulo Sérgio da Silva Santos

ABSTRACT

The purpose of this systematic review was to evaluate published data and to update our current knowledge about the impact on dental development of childhood hematopoietic stem-cell transplantation (HSCT), as well as the late effects of preparative regimens, for the treatment of onco-hematological malignancies. A systematic literature research was conducted to assess articles published since January 1980 until the present day that fi tted the predetermined inclusion/exclusion criteria. Data compilation was divided into qualitative and quantitative dental development disturbances. Demographic records were also gathered. First and second premolars and second molars were signifi cantly more affected in HSCT children. There was a positive correlation between age at the time of anticancer therapy administration and qualitative and quantitative dental development disturbances. The association of total body or head and neck radiation mieloablative treatments was shown to enhance the magnitude of dental development disturbances. Dental development disturbances due to childhood HSCT are commonly seen in long-term survivors. The knowledge of these alterations may help improve dental care and elevate the quality of life of these patients. Further studies are needed to understand the long-term effects of dental development disturbances in this group of patients.

http://www.revistas.usp.br/clrd/article/view/84385

Assessing the relationship between oral chronic graft-versus-host disease and global measures of quality of life

Summary

Objective

Chronic GVHD (cGVHD) is a frequent complication of allogeneic hematopoietic stem cell transplantation (HSCT) and affects multiple organ systems, with the oral cavity being one of the most frequently affected sites. Patients with cGVHD experience reduced quality of life (QOL), yet the specific impact of oral cGVHD on QOL is poorly understood. The objective of this study was to characterize the impact of oral cGVHD on global measures of QOL.

Materials and methods

QOL data were collected using the FACT-BMT and SF-36 instruments for 569 patients enrolled in the Chronic GVHD Consortium, with a total of 1915 follow-up visits. At study enrollment, patients were categorized as isolated oral cGVHD (n = 22), oral and concomitant extra-oral cGVHD (n = 420), and only extra-oral cGVHD (n = 127). Utilizing all longitudinal data, QOL scores were compared using a multivariable linear model controlling for demographic, transplant, and cGVHD characteristics.

Results

Patients with isolated oral cGVHD reported better physical well-being (P = 0.009), BMT well-being (P = 0.01), and decreased bodily pain (P = 0.01) compared to patients with oral and concomitant extra-oral cGVHD, but the differences in scores did not reach the defined threshold for clinical significance (6 points for FACT-BMT domains and 5 points for SF-36 domains).

Conclusions

Global QOL scores are similar in patients with isolated oral cGVHD and patients with oral and concomitant extra-oral cGVHD.

http://www.sciencedirect.com/science/article/pii/S1368837515002882

Grupo de pesquisa estuda transplantados através de videoconferência

Despontavam os anos 2000 quando um grupo de cirurgiões dentistas da Faculdade de Odontologia da Universidade de São Paulo (FOUSP) decidiu se reunir para debater os casos, cada vez mais frequentes, de pacientes transplantados que frequentavam o Cape (Centro de Atendimento a Pacientes Especiais). Inaugurado dentro da USP e contando com cinco profissionais, hoje o grupo formado há 15 anos compreende cinco instituições de pesquisa no Brasil e realiza reuniões mensalmente. Como todos esses profissionais se encontram? Por meio  de videoconferências.

“Em cada reunião, cada instituição dá uma palestra”, explica Karin Sá Fernandes, pesquisadora da FO e membro do GEPT (Grupo de Estudos em Pacientes Transplantados) desde 2005. Durante uma hora por mês, das 17h às 18h, as instituições debatem sobre casos clínicos de pacientes em fase de transplante e pesquisas desenvolvidas no meio. O grupo, que reúne atualmente a FO, o Instituto Nacional do Câncer (Inca), o Hospital das Clínicas da Faculdade de Medicina da USP e as Faculdades de Odontologia de Bauru (FOB-USP) e de Ribeirão Preto (FORP-USP), desfruta da tecnologia das instituições para compartilhar seus conhecimentos e melhorar o atendimento dos pacientes em questão.

As reuniões acontecem de forma que os profissionais consigam expor suas novidades e dúvidas a respeito do tema. No dia agendado para cada instituição, o grupo ouve os cirurgiões-dentistas da vez falarem e logo em seguida debate sobre o tema em aberto. “Cinco horas inicia a reunião. A instituição responsável ministra a aula até às 17h40 e em seguida abrimos para discussão. É como se todos os participantes estivessem reunidos em uma sala, a diferença é que cada um está em um local diferente”, comenta Karin.

Segundo a pesquisadora, mais de um caso clínico já foi solucionado com a ajuda do grupo e, para que o conhecimento esteja disponível para pessoas de todo o país, o GEPT realiza a publicação de alguns dos casos estudados. Atualmente, as três faculdades envolvidas no grupo estão coletando informações para uma pesquisa em conjunto: questionários sobre o conhecimento dos estudantes de Odontologia em relação às doações e transplantes de órgãos  estão sendo utilizados para averiguar qual o contato dos alunos com o assunto.

 A iniciativa da agregação das cinco instituições partiu do coordenador do GEPT, Paulo Sérgio da Silva Santos. Tornando-se docente da Faculdade de Odontologia de Bauru,  Paulo entrou em contato com os técnicos da faculdade para checar as possibilidades de continuação do grupo mediante o uso da internet.Com o resultado positivo da experiência, os demais centros de pesquisa foram convidados a participar do grupo e de suas reuniões, ampliando com isso os debates sobre o tema.

A razão dos estudos

O número de transplantes no Brasil vem aumentando cada vez mais. Com a maior disponibilidade de recursos, médicos e doadores de órgãos no sistema público, em 2012 o Ministério da Saúde divulgou que, em comparação com o ano anterior, o aumento dessas operações foi de 12,7%.

De uma forma geral os pacientes transplantados têm uma baixa imunidade e necessitam de cuidados especiais, argumenta Karin. A pesquisadora diz que o GEPT tem uma ação importante nesse sentido porque, como são muitas as peculiaridades entre os transplantados, é necessário que os profissionais se auxiliem a fim de orientar o melhor atendimento odontológico para esses pacientes. “Eles [os pacientes] têm um tratamento peculiar pela imunossupressão, por todas as alterações bucais que eles apresentam antes e pós-transplante. Cada grupo é diferente”.

Como o corpo ainda não está forte o suficiente, sem os cuidados específicos a presença de  um foco de infecção na boca pode levar a diversas complicações, como a perda do transplante e a morte do paciente.

Tecnologia avançada

A FO é uma das instituições que mais investem na tecnologia de informações. Segundo uma pesquisa de mestrado sobre teleodontologia divulgada esse ano, todos os docentes da instituição utilizam diariamente a internet para fins pessoais e profissionais. Karin diz que nenhuma vez, desde que o grupo começou com as videoconferências, houve cancelamento de uma reunião por problemas técnicos da Faculdade.

Os resultados da pesquisa apontam um caminho próspero para a teleodontologia, setor que cresce dentro do SUS e recebe atenção especial da USP. Buscando o uso das tecnologias da informação e comunicação como auxiliares para atividades relacionadas à saúde à distância, a telessaúde é um eixo que possibilita a interação entre profissionais de saúde ou entre estes e seus pacientes, bem como o acesso remoto a recursos de apoio diagnósticos ou até mesmo terapêuticos.

Fonte: Faculdade de Odontologia 

http://www.usp.br/aun/exibir.php?id=6998&edicao=1223

Graft-versus-host disease affecting oral cavity. A review

Abstract

Graft versus host disease (GVHD) is one of the most frequent and serious complications of hematopoietic stem cell transplantation, and is regarded as the leading cause of late mortality unrelated to the underlying malignant disease. GVHD is an autoimmune and alloimmune disorder that usually affects multiple organs and tissues, and exhibits a variable clinical course. It can manifest in either acute or chronic form. The acute presentation of GVHD is potentially fatal and typically affects the skin, gastrointestinal tract and liver. The chronic form is characterized by the involvement of a number of organs, including the oral cavity. Indeed, the oral cavity may be the only affected location in chronic GVHD. The clinical manifestations of chronic oral GVHD comprise lichenoid lesions, hyperkeratotic plaques and limited oral aperture secondary to sclerosis. The oral condition is usually mild, though moderate to severe erosive and ulcerated lesions may also be seen. The diagnosis is established from the clinical characteristics, though confirmation through biopsy study is sometimes needed. Local corticosteroids are the treatment of choice, offering overall response rates of close to 50%. Extracorporeal photopheresis and systemic corticosteroids in turn constitute second line treatment. Oral chronic GVHD is not considered a determinant factor for patient survival, which is close to 52% five years after diagnosis of the condition. Key words:Chronic graft-versus-host disease, oral chronic graft-versus-host disease, pathogenics, management, survival.

https://www.researchgate.net/publication/272431394_Graft-versus-host_disease_affecting_oral_cavity._A_review

Cytomegalovirus infection in transplant recipients

Cytomegalovirus infection in transplant recipients

Luiz Sergio Azevedo, Lıgia Camera Pierrotti, Edson Abdala, Silvia Figueiredo Costa, Tania Mara Varejao Strabelli, Silvia Vidal Campos, Jessica Fernandes Ramos, Acram Zahredine Abdul Latif, Nadia Litvinov, Natalya Zaidan Maluf, Helio Hehl Caiaffa Filho, Claudio Sergio Pannuti, Marta Heloisa Lopes, Vera Aparecida dos Santos, Camila da Cruz Gouveia Linardi, Maria Aparecida Shikanai Yasuda, Heloisa Helena de Sousa Marques

Cytomegalovirus infection in transplant recipients.. Available from: https://www.researchgate.net/publication/280586630_Cytomegalovirus_infection_in_transplant_recipients [accessed Aug 4, 2015].

Cytomegalovirus infection is a frequent complication after transplantation. This infection occurs due to transmission from the transplanted organ, due to reactivation of latent infection, or after a primary infection in seronegative patients and can be defined as follows: latent infection, active infection, viral syndrome or invasive disease. This condition occurs mainly between 30 and 90 days after transplantation. In hematopoietic stem cell transplantation in particular, infection usually occurs within the first 30 days after transplantation and in the presence of graft-versus-host disease. The major risk factors are when the recipient is cytomegalovirus seronegative and the donor is seropositive as well as when lymphocyte-depleting antibodies are used. There are two methods for the diagnosis of cytomegalovirus infection: the pp65 antigenemia assay and polymerase chain reaction. Serology has no value for the diagnosis of active disease, whereas histology of the affected tissue and bronchoalveolar lavage analysis are useful in the diagnosis of invasive disease. Cytomegalovirus disease can be prevented by prophylaxis (the administration of antiviral drugs to all or to a subgroup of patients who are at higher risk of viral replication) or by preemptive therapy (the early diagnosis of viral replication before development of the disease and prescription of antiviral treatment to prevent the appearance of clinical disease). The drug used is intravenous or oral ganciclovir; oral valganciclovir; or, less frequently, valacyclovir. Prophylaxis should continue for 90 to 180 days. Treatment is always indicated in cytomegalovirus disease, and the gold-standard drug is intravenous ganciclovir. Treatment should be given for 2 to 3 weeks and should be continued for an additional 7 days after the first negative result for viremia.


https://www.researchgate.net/publication/280586630_Cytomegalovirus_infection_in_transplant_recipients

A case of upper gingiva carcinoma with chronic graft-versus-host disease after allogenic bone marrow transplantation

A case of upper gingiva carcinoma with chronic graft-versus-host disease after allogenic bone marrow
transplantation
F Tsushima,* J Sakurai,* H Harada*
*Oral and Maxillofacial Surgery, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and
Dental University, Tokyo, Japan.
ABSTRACT
Oral squamous cell carcinoma (OSCC) is one of the most common solid tumours occurring after haematopoietic stem cell transplantation (HSCT), especially in patients with chronic graft-versus-host-disease (cGVHD). We describe a case of OSCC that developed in a 51-year-old male 22 years after he had received allogeneic HSCT from his human leukocyte antigen-identical sister as a treatment for acute myelocytic leukaemia. The patient had presented with multiple white patchy lesions on the palatal gingiva and mucosa 16 years after HSCT; these lesions were consistent with the clinical features of cGVHD. Six years later, oral examination and biopsy revealed upper gingival squamous cell carcinoma (SCC) in areas of cGVHD, and he underwent tumour excision. Follow-up examination at 2 years and 4 months after the operation revealed no evidence of recurrence of local SCC or metastasis of the cervical lymph node. The current case highlights the susceptibility of patients with cGVHD to the development of OSCC even two decades after HSCT. Therefore, we recommend careful long-term follow-up of the oral cavity for patients with cGVHD.

http://onlinelibrary.wiley.com/doi/10.1111/adj.12343/full

XVIII ENCONTRO DE ENFERMAGEM E EQUIPE MULTIDISCIPLINAR EM TRANSPLANTE DE MEDULA ÓSSEA

XVIII ENCONTRO DE ENFERMAGEM E EQUIPE MULTIDISCIPLINAR EM TRANSPLANTE DE MEDULA ÓSSEA

http://www.sbtmo2015.com.br/

Dent Res J (Isfahan). 2015 May-Jun;12(3):199-208.

Oral manifestations in transplant patients.

Nappalli D1, Lingappa A2.

Author information

Abstract

Organ transplantation is a widely undertaken procedure and has become an important alternative for the treatment of different end-stage organ diseases that previously had a poor prognosis. The field of organ transplant and hematopoietic stem cell transplant is developing rapidly. The increase in the number oftransplant recipients also has an impact on oral and dental services. Most of the oral problems develop as a direct consequence of drug-induced immunosuppression or the procedure itself. These patients may present with oral complaints due to infections or mucosal lesions. Such lesions should be identified, diagnosed, and treated. New treatment strategies permit continuous adaptation of oral care regimens to the changing scope of oral complications. The aim of this review is to analyze those oral manifestations and to discuss the related literature.

http://www.ncbi.nlm.nih.gov/pubmed/26005458

XIV Congresso Brasileiro de Transplantes

Veja na programação o 3º Simpósio de Odontologia em Transplantes e participe!
http://www.congressoabto.org.br/2015/programa/24/

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