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Background: There is a lack of studies analyzing the association between oral mucositis (OM) and nutritional imbalance in children during hematopoietic stem cell transplantation (HSCT). The aim of this study was to compare the risk factors for OM and nutritional imbalance during HSCT in pediatric patients with nonmalignant diseases (NMD) and malignant diseases (MD). Methods: Data on age, sex, primary disease, transplantation type, conditioning regimen, GVHD prophylaxis, gastrointestinal toxicity, OM, percent body weight loss or gain, nutritional repositioning, and overall survival (OS) were retrospectively collected from the 132 medical records. The data were then compared between patients with NMD (n = 70) and MD (n = 62). Results: OM had a similar severity between the groups. The primary risk factor for OM in the NMD group was the conditioning regimen with busulfan, while in the MD group it was GVHD prophylaxis with cyclosporin and methotrexate. OM did not have an impact on body weight loss or gain in any of the groups. In the NMD, body weight gain due to fluid overload was more pronounced and associated with a lower age range. OS was similar between the groups and was not affected by OM. Conclusions: OM pattern was similar in pediatric patients with or without MD, but the factors that determined these oral lesions were different. There were disparities in body weight changes between the two groups, and these changes were not associated to OM. [ABSTRACT FROM AUTHOR]

Accumulated evidence has shown that the oral cavity may be an important reservoir for SARS-CoV-2. Some authors have suggested that the use of mouthrinses could reduce SARS-CoV-2 viral load in the saliva. Thus, the aim of this review was to synthesize evidence about the efficacy of mouthrinses in reducing the salivary viral load of SARS-CoV-2. 2. Nine randomized controlled trials (RCTs) have investigated the efficacy of different mouthrinses in reducing salivary SARS-CoV-2 loads. Various active ingredients have been tested in these trials: 0.5%,1% and 2% povidone-iodine, 0.2% and 0.12% chlorhexidine (CHX), 0.075% cetylpyridinium chloride (CPC), 0.075% CPC with Zinc lactate, 1% and 1.5% hydrogen peroxide (HP), 1.5% HP + 0.12% CHX and ß-cyclodextrin and citrox. The studies reported an intra-group reduction in the salivary levels of the virus, when compared with the baseline. However, the majority of these trials failed to demonstrate a significant inter-group difference between active groups and the control group relative to the decrease in salivary SARS-CoV-2 loads. Although promising, these results should be confirmed by larger trials. [ABSTRACT FROM AUTHOR]

Aim: To detect the type and frequency of oral lesions and clinical conditions suggestive of saliva alterations in COVID‐19 patients in an intensive care unit (ICU), as well as to describe the patient´s management in each case Methods: Information about oral conditions and mechanical ventilation was collected from oral medicine records of COVID‐19 patients in an ICU (n = 519) Results: From the total collected, 472 patients (90.9%) were examined by the oral medicine staff. In 242/472 patients (51.3%), alterations in the oral cavity were noted. The most frequent changes were mechanical trauma (18.1%, derived mainly from intubation), vascular/coagulation disturbances (24.1%, petechiae, bruises, varicoses, and oral bleeding), and saliva alterations (24.4%, dry mouth, and sialorrhea). Infectious lesions were mentioned in the oral medicine records (16.9%), most associated with a viral infection (15.7%), mainly herpesvirus. Improved oral change protocols included oral hygiene, use of specific medications, and laser therapy Conclusion: COVID‐19 patients in the ICU often showed dryness in the oral and mucosa oral lesions related to vascular/coagulation disturbances, and mechanical trauma derived from orotracheal tube. An oral medicine staff must be aligned with the ICU multidisciplinary team to manage COVID‐19 patients, as well as to establish diagnoses and oral cavity treatments. [ABSTRACT FROM AUTHOR]

Nivolumab, an antibody against anti‐programmed death type 1, has been used for treatment of advanced non‐small cell lung cancer with improvement of overall survival. Usually, diarrhea, cutaneous rash, and pruritus are reported as the most common immune‐related adverse effects of nivolumab therapy. Oral lesions and secondary adrenal insufficiency sometimes occur but usually are rare events. We report a case of a patient treated with nivolumab who then showed persistent oral ulcerative and lichenoid lesions, which were refractory to topical corticosteroids. The oral lesions were concomitant to nivolumab‐induced adrenal insufficiency. These adverse events led to nivolumab discontinuation, which favored oral lesion healing and adrenal insufficiency remission. Through a brief review of the literature concerning nivolumab toxicity in the oral cavity, we discuss the clinical aspect and management of these lesions. [ABSTRACT FROM AUTHOR]

Busulfan is a major component of chemotherapy conditioning in hematopoietic cell transplantation (HCT). This alkylating agent is highly toxic at myeloablative doses, exposing HCT patients to risks of mortality. Non-myeloablative (NMA) and reduced-intensity conditioning (RIC) using busulfan have shown impaired toxicity. However, the toxicity of NMA/RIC in the digestive tract is poorly described. This study aimed to characterize the mucositis in the oral cavity (OM), oropharynx/esophagus, and gastrointestinal tract derived from conditionings with myeloablative and non-myeloablative doses of busulfan. We retrospectively retrieved clinical data of HCT patients (n = 100) who underwent myeloablative conditioning (MAC) or NMA/RIC with busulfan. Frequency and time duration of mucositis in the oral cavity and oropharynx/esophagus, diarrhea, and prescription of total parenteral nutrition (TPN) and opioids were also collected. OM severity (p = 0.009) and time duration of mucositis in oropharynx/esophagus (p = 0.022) were frequently higher in MAC than NMA/RIC. A myeloablative dose of busulfan was a risk factor for OM grade ≥ 2 (OR = 4.8, p = 0.002) and for mucositis in oropharynx/esophagus ≥ 5 days (OR = 2.64, p = 0.035). A longer duration of mucositis in the oropharynx/esophagus was also associated with an increase in the prescription of opioids (OR = 7.10, p < 0.001).Overall survival (OS) in MAC was significantly higher than that in NMA/RIC (p = 0.017). No variables related to mucositis interfere significantly in OS. In conclusion, myelosuppression in busulfan-based regimens are predisposed to a high risk for severe OM and to prolonged mucositis in the oropharynx/esophagus. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate whether digestive tract mucositis is a predictive factor for body weight (BW) alterations during hematopoietic stem cell transplantation (HSCT). Data about characteristics of transplantation, initial nutritional conditions and gastrointestinal mucositis were collected from adult patients (n= 105) who underwent autologous and allogeneic HSCT. Oral mucositis (OM) was not a predictive factor for BW loss, but it was an independent factor for BW gain in autologous HSCT (β = 0.329,P= 0.021). Busulfan-fludarabine conditioning regimen (β = 1.531,P= 0.011) and gender (β = 1.109,P= 0.038) were significant independent risk factors for BW loss in allogeneic HSCT. Overall survival (OS) was significantly affected by the duration of OM in autologous HSCT (HR = 1.243,P= 0.008). In allogeneic HSCT, BW loss (HR = 1.308,P= 0.049) and diarrhea (HR = 1.139,P= 0.012) interfered significantly with OS. In conclusion, OM was not a risk factor for BW loss, but it influenced BW gain and had a negative impact on OS in autologous HSCT patients. Intestinal mucositis explained partially the BW loss and had a negative impact on OS in allogeneic HSCT. [ABSTRACT FROM AUTHOR]

Melphalan followed by hematopoietic stem-cell transplantation (HSCT) is the standard treatment for multiple myeloma and other hematopoietic neoplasms. However, high doses of melphalan cause severe oral mucositis (OM). The objective was to verify the efficacy of cryotherapy plus laser therapy on reduction of OM severity. HSCT patients undergoing melphalan chemotherapy (n = 71) were randomly divided into two groups according to OM treatment: oral cryotherapy performed with ice chips for 1 h 35 min followed by low-level laser therapy (InGaAIP, 660 nm, 40 mW, 6 J/cm(2) ) (n = 54) and laser therapy alone with the same protocol (n = 17). A control group (n = 33) was composed of HSCT patients treated with melphalan who received no specific treatment for OM. OM scores and clinical information were collected from D0 to D + 11. The cryotherapy/laser therapy group showed the lowest OM scores (maximum Grade I) and the lowest mean number of days (8 days) with OM in comparison with the other groups (p < 0.001). OM Grades III and IV were present with high frequency only in the control group. The association of cryotherapy with laser therapy was effective in reducing OM severity in HSCT patients who underwent melphalan conditioning. [ABSTRACT FROM AUTHOR]

Taste changes during hematopoietic steam cells transplantation (HSC) are often acknowledged after the transplantation, however little is known about which flavors and what types of perception changes are experienced by patients during this treatment. The aim of this study was to characterize taste and taste buds atrophy alterations present during the HSC, as well as to verify if there is association among these alterations and clinical variables related to the transplant and oral mucosal toxicity. The impact of taste and oral mucosa alterations on patients' quality of life was also evaluated. We selected 54 patients holding autologous and allogenic HSC, who underwent taste acuity tests prior to conditioning (T0), during neutropenia (T1) and engraftment (T2). It was carried out an acuity test in the perception of sweet, bitter, sour and salty flavors, offered in solutions containing low and high concentrations of watery substances stimulating these flavors. Patients were also submitted to oroscopy for evaluation of oral mucositis and taste buds atrophy. It was found that 69% of patients suffered taste alteration in T1 and 70% in T2. Also flavor intensity was wrongly reported more times by patients in T1 (79%) and T2 (78%) than prior to conditioning. Taste buds atrophy was observed in 74% of patients at T1 and 78% at T2, being correlated to change in the flavor (p = 0.037) at T2. Taste buds atrophy was inversely correlated to TBI treatment in their conditioning, with 42% of patients affected (p = 0.036). Finally, patients suffering mucositis for 7 days or longer presented more taste buds atrophy (p = 0.048).Conclusion: The oral mucositis duration, the conditioning regime and taste buds atrophy are factors that may be associated with greater taste alteration in patients submitted to HSC. [ABSTRACT FROM AUTHOR]

Regular analysis of demographic, clinical and outcome data is indispensable for ensuring and maintaining quality in a hematopoietic stem cell transplant (HSCT) center. For this, data needs to be extracted accurately. Organization accreditations such as FACT (Foundation for the Accreditation of Cellular Therapy) require submission of data to the US (CIBMTR) or the European (EBMT) Registries correctly. Due to discrepancies found between medical charts data and the data submitted to CIBMTR in the first FACT accreditation cycle (2012), our HSCT center decided to hire a dedicated data manager. We describe here the training and performance of the data manager in the process of collecting and transferring HSCT data to national and international registries. The professional hired as data manager received internal and external training. Externally, she attended national and international congresses and visited the CIBMTR (2016). Internally, she first received training by the clinical team about the forms to be filled in. Together with the HSCT multi-professional team, they evaluated the data collection process and defined which data should appear in the medical records. Appropriate outcomes were defined for data analysis based on literature searches, the FACT requirements and the need of the clinical staff, and the data manager was trained in data analysis using R. The clinical team together with data manager developed templates appropriate for the clinical follow-up of patients, such as the Dentistry to collect data on mucositis. The quality nurse developed a regular internal auditing system. One of the results was the reduction of three hours in filling out the forms (TED 2400). From the structuring, organization and updating of the database, it was possible to obtain relevant indicators on survival and cumulative incidence of acute and chronic graft versus host disease, transplant-related mortality and disease relapse. These are used by the HSCT team in clinical rounds and in critical analyses of the program performance. In re-accreditations (2015 and 2018) after hiring and training, no non-compliance was identified in item B9, related to the insertion and submission of transplant data. In 2017, the clinical team designed, with the data manager, an ethically-approved multicenter study until 2027, about on transplant-related outcomes, currently with 19 centers in Brazil that sending data to CIBMTR. Training of the data manager at our HSCT center (a profession not official in Brazil) allowed the development of strategies and tools that resulted in greater accuracy in data collection and analysis, and FACT-compliant. [ABSTRACT FROM AUTHOR]

During conditioning of hematopoietic stem cell transplantation, numerous chemotherapeutics are used, among them, busulfan (BU). This is an alkylating agent that generates intense toxicity induced by oxidative stress, which can lead to DNA damage and cause oral mucositis (MO). BU is found at salivary levels close to plasma levels, but it is not known whether salivary concentrations are toxic as much as plasma to the oral cavity. This work aimed to analyze oxidative stress and possible DNA damage in keratinocytes exposed to BU found in salivary doses. Human keratinocytes were cultured and the following groups were established: Control (no treatment), Control Saliva (exposure to artificial saliva) and BU (exposure to BU carried in saliva at 4.0, 4.5, 5.0 and 5.5 μg / mL). The cell viability and the number of cells with DNA fragmentation were evaluated by TUNEL assay, as well as the level of oxidative stress by quantification of sequestration of the radical DPPH, superoxide dismutase (SOD), catalase (CAT) and level of lipid peroxidation (PL). Through the comet assay, the percentage of fragmented DNA was evaluated. The effect of BU on keratinocytes was dose-dependent; the dose of 5.5 μg / mL without vehicle with saliva generated 76% cellular viability, differing from the Control group (p < 0.05); when the BU was delivered in saliva, all doses generated less viability than the BU without saliva (p < 0.001). In the TUNEL analysis, salivary BU treatment caused a higher frequency of cells with DNA fragmentation (p < 0.05 compared to controls), as well as lower sequestration potential of the DPPH radical (p < 0.05 compared to the controls). Catalase activity was higher in the BU group (p < 0.01 compared to the controls). Exposure to BU also generated a higher percentage of fragmented DNA (p < 0.05 compared to Control). It was concluded that the salivary concentration of BU is toxic to keratinocytes, inducing oxidative stress and increased DNA damage. [ABSTRACT FROM AUTHOR]