Microbial changes in relation to oral mucositis in autologous hematopoietic stem cell transplantation recipients.

The aim of this prospective, two center study was to investigate the dynamics of the microbial changes in relation to the development of ulcerative oral mucositis in autologous SCT (autoSCT) recipients. Fifty-one patients were diagnosed with multiple myeloma and treated with high-dose melphalan followed by autoSCT. They were evaluated before, three times weekly during hospitalization, and three months after autoSCT. At each time point an oral rinse was collected and the presence or absence of ulcerative oral mucositis (UOM) was scored (WHO scale). Oral microbiome was determined by using 16S rRNA amplicon sequencing and fungal load by qPCR. Twenty patients (39%) developed UOM. The oral microbiome changed significantly after autoSCT and returned to pre-autoSCT composition after three months. However, changes in microbial diversity and similarity were more pronounced and rapid in patients who developed UOM compared to patients who did not. Already before autoSCT, different taxa discriminated between the 2 groups, suggesting microbially-driven risk factors. Samples with high fungal load (>0.1%) had a significantly different microbial profile from samples without fungi. In conclusion, autoSCT induced significant and reversible changes in the oral microbiome, while patients who did not develop ulcerative oral mucositis had a more resilient microbial ecosystem.

Oral Care for Hematopoietic Stem Cell Transplantation Patients: A Narrative Review.

PURPOSE: Patients undergoing hematopoietic stem cell transplantation (HSCT) are at high risk of oral complications with the potential of causing significant morbidity and mortality. Dental professionals should play a fundamental role in the prevention and treatment of oral sequelae of HSCT. However, the dental community is not well informed and experienced in providing oral care of the oral complications for HSCT patients. This narrative review attempts to fill the knowledge gap through reviewing the oral complications and current recommendations for oral and dental care for the patient before, during and after HSCT. RESULTS: Oral care in the HSCT process was divided into five stages with the goal being to provide practical guidance for dental care providers to assist in managing these patients. It is well known that the maintenance of good oral health is important in cancer patients, including patients with hematologic malignancies. In addition to negatively impacting quality of life, oral pain and/or infections can cause delays, modification and discontinuation of life-saving cancer treatment. Oral complications can lead to new or extended hospitalization. By providing a preventive and treatment algorithm based on currently available literature reports and expert opinion, we can hope to achieve better patient outcomes. CONCLUSION: We present oral and dental management recommendations with a focus on oral health maintenance, infection prevention, pain control and oral complication management to support oral and general health of this medically complex patient population prior to, during and following HSCT.