Oral Mucositis in Pediatric Patients in Treatment for Acute Lymphoblastic Leukemia

Abstract

Oral mucositis in oncologic patients is the most undesirable event of the chemotherapeutic treatment. This study aimed to identify damage to the oral cavity resulting from chemotherapy in pediatric patients with acute lymphoblastic leukemia (ALL). This is a prospective study with a sample of 42 children and adolescents evaluated for 10 consecutive weeks after diagnosis. The modified Oral Assessment Guide (OAG) was used, and data were analyzed by Spearman’s rank correlation coefficient (α = 5%). Changes to the normal lips and saliva were positively related to an increase in the OAG score during all 10 weeks of evaluation. Alterations to the labial mucosa were correlated with an increase in the OAG score from the 2nd to 10th week, which was also found for changes in the tongue and in the swallowing function in Weeks 1, 6, 8, 9, and 10 and for gum changes from the 5th to 7th week. No significant vocal changes were correlated with the total OAG score at any point during the monitoring period. Changes in lips, cheek and/or palatal mucosa, labial mucosa, and gum areas and in swallowing function were positively correlated with an increase in the severity of oral mucositis in patients with ALL after beginning chemotherapeutic treatment.

Evaluation of the buccal mucosa of patients with acute lymphocytic leukemia: A case series study

“…9 Another study with 42 patients pointed to 54.8% (n=23) female patients, with a mean age of 7.1 (± 4.7) years (median 5, minimum 2 and maximum 18 years), and distributed the patients regarding the age at diagnosis in groups of 2 (n=7; 16.7%), 4 (n=8; 19.0%) and 5 (n=4; 9.5%) years. 8 The most affected gender in the present study counteracts the literature. Regarding age, some authors are unanimous when affirming that the age at diagnosis has a strong effect over the prognosis, with more favorable outcomes for younger patients.…”

“…23 The most common complications are mucositis, candidiasis, periodontitis, gingivitis, ulcers, petechiae, ecchymosis, erythema, gingival bleeding, xerostomia, mucosal pallor and leukemic gingival enlargement. [7][8][9]23 However, in a prospective evaluation from diagnosis to the 10 th week of treatment, alterations in saliva and lip mucosa were observed, because of the occurrence of severe buccal mucositis throughout almost all of the evaluation weeks. 8 In the present study, only a few patients presented buccal alterations, contrasting with previous reports.…”

“…[7][8][9]23 However, in a prospective evaluation from diagnosis to the 10 th week of treatment, alterations in saliva and lip mucosa were observed, because of the occurrence of severe buccal mucositis throughout almost all of the evaluation weeks. 8 In the present study, only a few patients presented buccal alterations, contrasting with previous reports. The clinical findings of erythema (D35 P/I), dry lips (D8 and D15 P/I) and xerostomia (D15 P/I) are reported by most of the literature.…”

“…5 Secondary complications, such as mucocutaneous pallor, fever, asthenia, lymphadenopathy, xerostomia, cushingoid facies, hemorrhage, mucositis, candidiasis, ulcers and alterations on the saliva constituents with swallowing impairment may arise as a consequence of the chemotherapy treatment. [6][7][8][9] The presence of microorganisms is an aggravating factor of those effects. 10 The type-1 herpes simplex virus (HSV-1) has an important role on the severity of chemotherapy-induced buccal mucositis in patients with hematological neoplasms, [10][11][12] as do the Epstein-Barr virus (EBV) and the cytomegalovirus (CMV), representing a threat to immunocompromised patients.…”

Prospective evaluation of clinical symptoms of chemotherapy‐induced oral mucositis in adult patients with acute leukemia: A preliminary study

“…However, in our study, the CIOM of the gingiva was not present in AML patients and was found in only one case of ALL patients. According to a recent study on oral mucositis in pediatric ALL patients, lip mucosa was the most frequently affected site, with the gingiva being a relatively uncommon site (Ribeiro, Limeira, Dias de Castro, & Ferreti Bonan, 2017). ALL is the most common and the most serious type of childhood cancer, accounting for about 80% of cases of leukemia between 0 and 19 years of age, and the prognosis for ALL is worse in adults over 30 years (Trencsenyi, Bako, Nagy, Kertai, & Banfalvi, 2015).…”