Association between oral management and complications after hematopoietic stem cell transplantation

Hematopoietic stem cell transplantation (HSCT) is associated with oral mucositis and infections due to intensive conditioning and immunosuppression. Although pretransplant oral management is recommended, its effectiveness remains unclear. This study examined the association between oral management by dentists before HSCT and the duration of severe oral mucositis, infections, and mortality using a nationwide inpatient database in Japan.

We conducted a retrospective cohort study using the Diagnosis Procedure Combination database. Patients who underwent HSCT between May 2018 and February 2022 were divided into two groups: those who received oral management by dentists before HSCT and those who did not. After 1:1 propensity score matching, we compared the duration of severe oral mucositis (defined as opioid use within 30 days after HSCT), infections (defined as concurrent use of antibiotics and blood cultures within 30 days after HSCT), and 30-day in-hospital mortality between the groups.

Among the 15,911 eligible patients (mean age 49.0 ± 17.6 years), 5546 (34.9%) received pre-HSCT oral management. Propensity score matching yielded 4945 pairs. No significant differences were observed in the duration of severe oral mucositis or in-hospital mortality between groups. However, the patients receiving oral management had a lower incidence of infection than those without oral management (55.1 vs. 59.5%; risk difference, -4.4; 95% confidence interval, -6.4 to -2.5).

Pre-HSCT oral management by dentists may not reduce the duration of severe oral mucositis or all-cause mortality, but may reduce post-transplant infections. Further studies are warranted to clarify the components of oral management that most effectively affect oral mucositis and mortality.