15 January 2020

Haematopoietic stem cell transplant patients with untreated oral infections are not at a raised risk of mortality in the six months after transplant, according to a new analysis.

Professor Tuomas Waltimo of the University of Basel, Switzerland, and colleagues looked at the link between common oral infections and survival or infectious complications after transplant.

They examined outcomes for 341 allogeneic and 125 autologous stem cell transplant recipients between 2008 and 2016. In the following six months, 14% of the allogeneic recipients and 3% of the autologous recipients died.

However, looking at measures of dental problems – acute or chronic oral infections, severity of decayed, missing or filled teeth, or periodontitis before transplant – the team found that none were linked with survival. These factors were also not linked to hospital-treated infectious diseases or severe infectious complications.

Writing in the journal PLoS One, the researchers conclude: “The results of this study suggest that radical dental interventions to chronic oral infections could be postponed until post-haematopoietic stem cell transplantation.”

Professor Waltimo said: “Contrary to our assumptions, untreated oral infections had no connection with post-stem cell transplantation survival during the six-month follow-up period. Another surprise was that they had no link with any serious infectious complications occurring during the follow-up period.”

This is most likely due to the long-term and broad-spectrum antimicrobial therapy given during treatment, he explains.

Professor Walitmo added: “Even though the cause of dental infections must always be eliminated, our study demonstrates that teeth need not be extracted just before a stem cell transplantation procedure due to chronic but asymptomatic dental infections.

“However, the patient's health permitting, and if the wound has enough time to heal before chemotherapy, the radical treatment of such infections is justified. Other than that, conservative, non-radical treatment appears to be the lowest-risk option in terms of infectious and bleeding complications.”

Source: Mauramo M, Grolimund P, Egli A, Passweg J, Halter J, Waltimo T (2019) “Associations of oral foci of infections with infectious complications and survival after haematopoietic stem cell transplantation”, PLoS ONE, doi: 10.1371/journal.pone.0225099


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