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Salivary secretion in children after fractionated or single-dose TBI
K Garming Legert1, M Remberger, O Ringdèn
1Department of Dental Medicine, Division of Oral and Maxillofacial Surgery, Karolinska Institute, Huddinge, Sweden.
Insights
Single-dose total body irradiation (sTBI) significantly reduces salivary secretion 1 year after hematopoietic stem cell transplant (HSCT) compared to fractionated TBI (fTBI). This oral complication is linked to conditioning regimen and herpesvirus infection.
Area of Science:
- Hematology
- Oncology
- Oral Medicine
Background:
- Long-term oral complications affect 60-100% of patients post-hematopoietic stem cell transplant (HSCT).
- Salivary dysfunction is a common and significant oral complication following HSCT.
- Conditioning regimens, including total body irradiation (TBI), are known risk factors for oral sequelae.
Purpose of the Study:
- To compare salivary secretion rates 1 year after HSCT in pediatric patients conditioned with single-dose TBI (sTBI) versus fractionated TBI (fTBI).
- To identify risk factors associated with low salivary secretion rates post-HSCT.
Main Methods:
- Prospective study of 44 pediatric patients undergoing HSCT.
- Measurement of unstimulated and stimulated salivary secretion rates (USSRs and SSSRs) before HSCT and at 1-year follow-up.
- Analysis of risk factors including conditioning regimen (sTBI vs. fTBI) and herpesvirus seropositivity.
Main Results:
- Significantly greater median reductions in both stimulated (56% vs. 12%) and unstimulated (74% vs. 33%) salivary flow were observed in the sTBI group compared to the fTBI group (P=0.003 for both).
- sTBI was a significant independent risk factor for low stimulated salivary secretion rate (OR=6.49, P=0.014).
- Recipient seropositivity for 3-4 herpesviruses also correlated significantly with low stimulated salivary secretion (OR=6.57, P=0.021).
Conclusions:
- Single-dose TBI is associated with a more severe reduction in salivary function 1 year after pediatric HSCT compared to fractionated TBI.
- Herpesvirus seropositivity is an additional risk factor contributing to salivary hypofunction post-HSCT.
- These findings highlight the importance of considering conditioning intensity and viral status in managing oral health after HSCT.
Abstract:
The incidence of long-term oral complications after hematopoietic SCT (HSCT) varies between 60 and 100%. The aim of this study was to compare the salivary secretion rate and the contribution of known risk factors for a low salivary secretion rate 1 year after HSCT in children conditioned with fractionated TBI (fTBI) and in children conditioned with single-dose TBI (sTBI). The study involved 44 patients, 27 conditioned with sTBI and 17 conditioned with fTBI. The unstimulated and stimulated salivary secretion rates (USSRs and SSSRs) were estimated before HSCT and at 1-year follow-up. Risk factors that may have influenced the salivary secretion rate were recorded. An SSSR of ≤0.5 mL/min and a USSR of ≤0.1 mL/min were chosen as cut-off points for salivary dysfunction. The median reduction in stimulated salivary flow 1 year after HSCT was 56% in the sTBI group and 12% in the fTBI group (P=0.003). The median reduction in unstimulated salivary flow 1 year after HSCT was 74% in the sTBI group and 33% in the fTBI group (P=0.003). In the multivariate model, a significant correlation between both sTBI (odds ratio (OR)=6.49, 95% confidence interval (CI)=1.40-30, P=0.014) and seropositivity of the recipient for 3-4 herpesviruses (OR=6.57, 95% CI=1.26-34, P=0.021) and a low stimulated salivary secretion rate (<0.5 mL/min) was found 1 year after HSCT.
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