Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia

BACKGROUND: Odontogenic diseases can be a risk factor for life-threatening infection in patients with hematologic malignancies during chemotherapy that induces myelosuppression of variable severity. Previous studies noted the necessity of the elimination of all odontogenic foci before hematopoietic...

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Autores principales: Akashi, Masaya, Shibuya, Yasuyuki, Kusumoto, Junya, Furudoi, Shungo, Inui, Yumiko, Yakushijin, Kimikazu, Okamura, Atsuo, Matsuoka, Hiroshi, Komori, Takahide
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751758/
https://www.ncbi.nlm.nih.gov/pubmed/23957921
http://dx.doi.org/10.1186/1472-6831-13-41
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author Akashi, Masaya
Shibuya, Yasuyuki
Kusumoto, Junya
Furudoi, Shungo
Inui, Yumiko
Yakushijin, Kimikazu
Okamura, Atsuo
Matsuoka, Hiroshi
Komori, Takahide
author_facet Akashi, Masaya
Shibuya, Yasuyuki
Kusumoto, Junya
Furudoi, Shungo
Inui, Yumiko
Yakushijin, Kimikazu
Okamura, Atsuo
Matsuoka, Hiroshi
Komori, Takahide
author_sort Akashi, Masaya
collection PubMed
description BACKGROUND: Odontogenic diseases can be a risk factor for life-threatening infection in patients with hematologic malignancies during chemotherapy that induces myelosuppression of variable severity. Previous studies noted the necessity of the elimination of all odontogenic foci before hematopoietic stem cell transplantation. To enable planning for the adequate dental intervention, the oral medicine team must understand the general status of patient and the intensity of the chemotherapy, which is sometimes difficult to be fully appreciated by dental staff. Therefore, a simplified grading would facilitate the sharing of information between hematologists, dentists and oral hygienists. This study aimed to introduce our myelosuppression grading of chemotherapies for hematologic malignancies and analyze the timing of occurrence of severe odontogenic infection. METHODS: 37 patients having received various chemotherapies for hematologic malignancies were enrolled. The chemotherapy regimens were classified into four grades based on the persistency of myelosuppression induced by chemotherapy. Mild myelosuppressive chemotherapies were classified as grade A, moderate ones as grade B, severe ones as grade C, and chemotherapies that caused severe myelosuppression and persistent immunodeficiency (known as conditioning regimens for transplant) as grade D. The timing of occurrence of severe odontogenic infection was retrospectively investigated. RESULTS: Two patients (5.4%) had severe odontogenic infections after grade B or C chemotherapy. One occurred after extraction of non-salvageable teeth; the other resulted from advanced periodontitis in a tooth that could not be extracted because of thrombocytopenia. Both were de novo hematologic malignancy patients. During grade D chemotherapy, no patients had severe odontogenic infections. CONCLUSIONS: The simplified grading introduced in this study is considered a useful tool for understanding the myelosuppressive state caused by chemotherapy and facilitating communication between medical and dental staff. During the period around the primary chemotherapy, especially for de novo hematologic malignancy patients who often received grade B to C myelosuppression chemotherapy, caution should be exercised for severe odontogenic infection by the oral medicine team, irrespective of whether invasive treatment is to be performed.
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spelling pubmed-37517582013-08-24 Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia Akashi, Masaya Shibuya, Yasuyuki Kusumoto, Junya Furudoi, Shungo Inui, Yumiko Yakushijin, Kimikazu Okamura, Atsuo Matsuoka, Hiroshi Komori, Takahide BMC Oral Health Research Article BACKGROUND: Odontogenic diseases can be a risk factor for life-threatening infection in patients with hematologic malignancies during chemotherapy that induces myelosuppression of variable severity. Previous studies noted the necessity of the elimination of all odontogenic foci before hematopoietic stem cell transplantation. To enable planning for the adequate dental intervention, the oral medicine team must understand the general status of patient and the intensity of the chemotherapy, which is sometimes difficult to be fully appreciated by dental staff. Therefore, a simplified grading would facilitate the sharing of information between hematologists, dentists and oral hygienists. This study aimed to introduce our myelosuppression grading of chemotherapies for hematologic malignancies and analyze the timing of occurrence of severe odontogenic infection. METHODS: 37 patients having received various chemotherapies for hematologic malignancies were enrolled. The chemotherapy regimens were classified into four grades based on the persistency of myelosuppression induced by chemotherapy. Mild myelosuppressive chemotherapies were classified as grade A, moderate ones as grade B, severe ones as grade C, and chemotherapies that caused severe myelosuppression and persistent immunodeficiency (known as conditioning regimens for transplant) as grade D. The timing of occurrence of severe odontogenic infection was retrospectively investigated. RESULTS: Two patients (5.4%) had severe odontogenic infections after grade B or C chemotherapy. One occurred after extraction of non-salvageable teeth; the other resulted from advanced periodontitis in a tooth that could not be extracted because of thrombocytopenia. Both were de novo hematologic malignancy patients. During grade D chemotherapy, no patients had severe odontogenic infections. CONCLUSIONS: The simplified grading introduced in this study is considered a useful tool for understanding the myelosuppressive state caused by chemotherapy and facilitating communication between medical and dental staff. During the period around the primary chemotherapy, especially for de novo hematologic malignancy patients who often received grade B to C myelosuppression chemotherapy, caution should be exercised for severe odontogenic infection by the oral medicine team, irrespective of whether invasive treatment is to be performed. BioMed Central 2013-08-19 /pmc/articles/PMC3751758/ /pubmed/23957921 http://dx.doi.org/10.1186/1472-6831-13-41 Text en Copyright © 2013 Akashi et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Akashi, Masaya
Shibuya, Yasuyuki
Kusumoto, Junya
Furudoi, Shungo
Inui, Yumiko
Yakushijin, Kimikazu
Okamura, Atsuo
Matsuoka, Hiroshi
Komori, Takahide
Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia
title Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia
title_full Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia
title_fullStr Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia
title_full_unstemmed Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia
title_short Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia
title_sort myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751758/
https://www.ncbi.nlm.nih.gov/pubmed/23957921
http://dx.doi.org/10.1186/1472-6831-13-41
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