OBJECTIVES:Oral mucositis is a complication frequently associated with hematopoietic stem cell transplantation, decreasing a patient's quality of life and increasing the occurrence of opportunistic infections. The purpose of this study was to determine the incidence and severity of oral mucositis and to assess the correlation of this disease with the oral health of an individual at the time of hematopoietic stem cell transplantation.METHODS:Before transplantation, patients' oral health and inflammatory conditions were determined using the gingival index and the plaque index, which are based on gingival bleeding and the presence of dental plaque, respectively. Additionally, the dental health status was determined using the decayed, missing, and filled teeth index. The monitoring of oral mucositis was based on the World Health Organization grading system and was performed for five periods: from Day 0 to D+5, from D+6 to D+10, from D+11 to D+15, from D+16 to D+20, and from D+21 to D+30.RESULTS:A total of 97 patients (56% male and 44% female) who underwent hematopoietic stem cell transplantation at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo between January 2008 and July 2009 were prospectively examined. The incidence of ulcerative mucositis was highest from days +6 to +10 and from days +11 to +15 in the patients who underwent autologous and allogeneic hematopoietic stem cell transplantation, respectively.CONCLUSION:The data, including the dental plaque and periodontal status data, showed that these oral health factors were predictive of the incidence and severity of oral mucositis in a cohort of patients with similar conditioning regimens before hematopoietic stem cell transplantation.

IntroductionAutologous hematopoietic stem cell transplantation is a conduct used to treat some hematologic diseases and to consolidate the treatment of others. In the field of nursing, the few published scientific studies on nursing care and early hospital discharge of transplant patients are deficient. Knowledge about the diseases treated using hematopoietic stem cell transplantation, providing guidance to patients and caregivers and patient monitoring are important nursing activities in this process. Guidance may contribute to long-term goals through patients’ short-term needs.AimTo analyze the results of early hospital discharge on the treatment of patients submitted to autologous transplantation and the influence of nursing care on this conduct.MethodsA retrospective, quantitative, descriptive and transversal study was conducted. The hospital records of 112 consecutive patients submitted to autologous transplantation in the period from January to December 2009 were revisited. Of these, 12 patients, who remained in hospital for more than ten days after transplantation, were excluded from the study.ResultsThe medical records of 100 patients with a median age of 48.5 years (19–69 years) were analyzed. All patients were mobilized and hematopoietic stem cells were collected by leukapheresis. The most common conditioning regimes were BU12Mel100 and BEAM 400. Toxicity during conditioning was easily managed in the outpatient clinic. Gastrointestinal toxicity, mostly Grades I and II, was seen in 69% of the patients, 62% of patients had diarrhea, 61% of the patients had nausea and vomiting and 58% had Grade I and II mucositis. Ten patients required hospitalization due to the conditioning regimen. Febrile neutropenia was seen in 58% of patients. Two patients died before Day +60 due to infections, one with aplasia. The median times to granulocyte and platelet engraftment were 12 days and 15 days, respectively, with median red blood cell and platelet transfusions until discharge of three and four units, respectively. Twenty-three patients required rehospitalization before being discharged from the outpatient clinic.ConclusionThe median time to granulocyte engraftment was 12 days and during the aplasia phase few patients were hospitalized or suffered infections. The toxicity of the conditioning was the leading cause of rehospitalization. The nursing staff participated by providing guidance to patients and during the mobilization, transplant and outpatient follow-up phases, thus helping to successfully manage toxicity.

Agradecimento Especial Aos meus pais Márcia e José, por toda dedicação, empenho e responsabilidade na minha educação. ... por serem a minha inspiração de vida e a quem eu devo todo meu amor, admiração e gratidão. Agradecimentos À Deus por ter permitido que um grande sonho se tornasse realidade. Ao meu orientador, Prof. Dr. Frederico Luiz Dulley pela oportunidade, confiança e credibilidade a mim dedicados na confecção desta Dissertação e no crescimento profissional. Paulo, que me acolhe desde os meus tempos de estagiária e diariamente me proporciona um novo aprendizado. À minha amiga Priscila Tavares Musqueira Cosenza pela imensa ajuda, companheirismo e apoio, sem os quais teria sido mais difícil concluir este estudo. Ao amigo Fábio Luiz Coracin pela valiosa ajuda despendida ao longo desta dissertação e também pela contribuição para o meu crescimento profissional. À minha irmã Andrea Barban pelo incentivo e por acreditar nos meus sonhos. Ao amigo Carlos Henrique Moreira da Cunha por ter participado do início da coleta de dados. À minha amiga Fabiane Almeida Mota Milanez por toda a preocupação e empenho. Aos colegas de equipe do Ambulatório de TMO, pelo companheirismo, dedicação e confiança, especialmente ao colega Landri de Souza Júnior pela solicitude em retirar os prontuários no Setor de Arquivo Médico. Ao Serviço de Hematologia do HCFMUSP, na pessoa do Prof. Dr. Dalton de Alencar Fischer Chamone pela oportunidade em trabalhar na equipe e por acreditar na minha capacidade profissional. À Divisão de Enfermagem do Instituto Central, na pessoa da Dra. Floracy Gomes Ribeiro, pela confiança, solicitude e atenção desde o fomento que fomos incorporados à esta Divisão. À Enfermeira Celina Campos de Araújo, pelo estímulo presente, incentivo e interesse no desfecho desta dissertação.