AKUT MİYELOİD LÖSEMİDE GÖZLENEN ORAL KOMPLİKASYONLAR

Abstract

Akut miyeloid Lösemi (AML), hematopoietik kök hücrelerden kaynaklanan heterojen bir hematolojik bozukluk grubudur. Bu hastalığın prognozu kötüdür bununla birlikte son 30 yılda yeni tedavi modalitelerin sayesinde genel sağkalımı önemli ölçüde iyileşmiştir. Oral lezyonların belirtileri ve semptomlarının tanımlanması, ciddi sistemik tutulumun bir uyarı işareti olarak işlev görebilir. Akut miyeloid Lösemi vakaların oral bulguları peteşi, spontan kanama, mukozal ülserasyon, nekrozlu veya nekrozsuz dişeti hipertrofisi, enfeksiyonlar, dilde hemorajik buller olarak görülmektedir. Kötü ağız hijyeni , lokal ve sistemik enfeksiyöz komplikasyonlar için bilinen bir risk faktörüdür. AML tedavisine bağlı ağız ve diş komplikasyonları dişleri , ağız mukozasını ve kemik dokusunu etkileyebilir ve fırsatçı enfeksiyonlara , diş çürümesine ve mine renginin bozulmasına katkıda bulunabilir. AML tedavisi yüksek mortalite ve morbidite ile ilişkilidir. Çoklu kemoterapi ve allojenij kemik iliği transplantasyonu içeren tedavi yöntemleri mevcut. Lösemili hastaların periodontal ve dental tedavileri her zaman hematologlarla birlikte planlanmalıdır.

Keywords

• akut miyeloid lösemi
• oral komplikasyon
• tedavi

ORAL COMPLICATIONS OBSERVED IN ACUTE MYELOID LEUKEMIA

Abstract

Acute myeloid leukemia (AML) is a heterogeneous group of hematological disorders. This disease has a poor prognosis however, overall survival has improved significantly over the past 30 years thanks to new treatment modalities. Identification of signs and symptoms of oral lesions can serve as a warning about severity of systemic involvement. Oral findings of acute myeloid leukemia cases can be listed as petechiae, spontaneous bleeding, mucosal ulceration, gingival hypertrophy with or without necrosis, infections, and hemorrhagic bullae on the tongue. Poor oral hygiene is a well- known risk factor for local and systemic infectious complications. Oral and dental complications associated with AML treatment can affect teeth, oral mucosa and bone tissue and contribute to opportunistic infections, tooth decay and enamel discoloration. AML treatment is associated with high mortality and morbidity. There are treatment modalities that include chemotherapy and allogeneic bone marrow transplantation. Periodontal and dental treatments of patients with leukemia should always be consulted together with hematologists.

Keywords

• acute myeloid leukemia
• oral complication
• treatment

References

1. 1- Fernandes, K.S.; Gallottini, M.; Castro, T.; Amato, M.F.; Lago, J.S.; Silva, P.H.B. Gingival leukemic infiltration as the first manifestation of acute myeloid leukemia. Spec. Care Dent. 2018, 38, 160–162.
2. 2- Reenesh, M.; Munishwar, S.; Rath, S.K. Generalised Leukaemic Gingival Enlargement: A Case Report. J. Oral Maxillofac. Res. 2012, 3, 5.
3. 3- Lupi, S.M.; Baena, A.R.Y.; Cervino, G.; Todaro, C.; Rizzo, S. Long-Term Effects of Acute Myeloid Leukemia Treatment on the Oral System in a Pediatric Patient. Open Dent. J. 2018, 12, 230–237.
4. 4- Adisen, M.Z.; Yilmaz, S.; Misirlioǧlu, M. Diagnosis of acute myeloid leukemia in a dental hospital; report of a case with severe gingival hypertrophy. Niger. J. Clin. Pr. 2015, 18, 573.
5. 5- Chowdhri, K.; Tandon, S.; Lamba, A.K.; Faraz, F. Leukemic gingival enlargement: A case report and review of literature. J. Oral Maxillofac. Surg. Med. Pathol. JOMFP 2018, 22, S77–S81.
6. 6- Shankarapillai, R.; Nair, M.A.; George, R.; Walsh, L.J. Periodontal and gingival parameters in young adults with acute myeloid leukaemia in Kerala, South India. Oral Health Prev. Dent. 2010, 8, 395–400.
7. 7- Walter, R.B.; Estey, E.H. Acute Myeloid Leukemia. Emerg. Cancer Ther. 2011, 2, 219–237.
8. 8- Im, H.J. Current treatment for pediatric acute myeloid leukemia. Blood Res. 2018, 53, 1–2.

9. 9- Gowda, T.M.; Thomas, R.; Shanmukhappa, S.M.; Agarwal, G.; Mehta, D.S. Gingival enlargement as an early diagnostic indicator in therapy-related acute myeloid leukemia: A rare case report and review of literature. J. Indian Soc. Periodontol. 2013, 17, 248–252.
10. 10- George, N.; Santhosh, V.C.; Kumar, H.; Gopal, S. Gingival enlargement in myelodysplastic syndrome. J. Indian Soc. Periodontol. 2015, 19, 687–689.
11. 11- Lynch, M.; Ship, I. Oral manifestations of leukemia: A postdiagnostic study. J. Am. Dent. Assoc. 1967, 75, 1139–1144.
12. 12- Dreizen, S.; McCredie, K.B.; Keating, M.J.; Luna, M.A. Malignant gingival and skin “infiltrates” in adult leukemia. Oral Surg. Oral Med. Oral Pathol. 1983, 55, 572–579.
13. 13- Ishikawa, S.; Kato, Y.; Kabasawa, T.; Yoshioka, C.; Kitabatake, K.; Yamakawa, M.; Ishizawa, K.; Iino, M. A case of myeloid sarcoma of the mandibular gingiva as extramedullary relapse of acute myeloid leukemia. Oral Maxillofac. Surg. 2019, 24, 121–126.
14. 14- Allareddy, V.; Prakasam, S.; Allareddy, V.; I Martinez-Schlurmann, N.; Rampa, S.; Nalliah, R.; Eswaran, S.V.K.; Elangovan, S. Poor Oral Health Linked with Increased Risk of Infectious Complications in Adults with Leukemia. J. Mass. Dent. Soc. 2015, 64, 38–42.
15. 15- Reynolds, M.A.; Minah, G.E.; Peterson, D.E.; Weikel, D.S.; Williams, L.T.; Overholser, C.D.; DePaola, L.G.; Suzuki, J.B. Periodontal disease and oral microbial successions during myelosuppressive cancer chemotherapy*. J. Clin. Periodontol. 1989, 16, 185–189.
16. 16- Djuric, M.; Hillier-Kolarov, V.; Belic, A.; Janković, L. Mucositis prevention by improved dental care in acute leukemia patients. Support. Care Cancer 2005, 14, 137–146.
17. 17- Zarina, R.S.R.; Nik-Hussein, N.N. Dental abnormalities of a long-term survivor of a childhood hematological malignancy: Literature review and report of a case. J. Clin. Pediatr. Dent. 2005, 29, 167–174.
18. 18- Wu, J.; Fantasia, J.E.; Kaplan, R. Oral Manifestations of Acute Myelomonocytic Leukemia: A Case Report and Review of the Classification of Leukemias. J. Periodontol. 2002, 73, 664–668.
19. 19- Ellegaard, B.; Bergmann, O.J.; Ellegaard, J. Effect of plaque removal on patients with acute leukemia. J. Oral Pathol. Med. 1989, 18, 54–58.
20. 20- McGaw, W.; Belch, A. Oral complications of acute leukemia: Prophylactic impact of a chlorhexidine mouth rinse regimen. Oral Surg. Oral Med. Oral Pathol. 1985, 60, 275–280.
21. 21- Fu, R.; Gundrum, J.; Sung, A.H. Health-care utilization and outcomes of patients at high risk of invasive fungal infection. Clin. Outcomes Res. 2018, 10, 371–387. [
22. 22- Gürgan, C.; Ozcan, M.; Karakuş, Ö.; Zincircioğlu, G.; Arat, M.; Soydan, E.; Topçuoğlu, P.; Gürman, G.; Bostancı, H. Periodontal status and post-transplantation complications following intensive periodontal treatment in patients underwent allogenic hematopoietic stem cell transplantation conditioned with myeloablative regimen. Int. J. Dent. Hyg. 2012, 11, 84–90
23. 23- Pour-Fard-Pachekenari, A.K.; Rahmani, A.; Ghahramanian, A.; Asghari-Jafarabadi, M.; Onyeka, T.C.; Davoodi, A. The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: A single-blind clinical trial. Clin. Oral Investig. 2018, 23, 1811–1821.
24. 24- Epstein, J.B.; Raber-Durlacher, J.E.; Huysmans, M.-C.; Schoordijk, M.C.; Cheng, J.E.; Bensadoun, R.-J.; Arany, P.R. Photobiomodulation Therapy Alleviates Tissue Fibroses Associated with Chronic Graft-Versus-Host Disease: Two Case Reports and Putative Anti-Fibrotic Roles of TGF-β. Photomed. Laser Surg. 2018, 36, 92–99.
25. 25- Lauritano, D.; Petruzzi, M. Decayed, missing and filled teeth index and dental anomalies in long-term survivors leukaemic children: A prospective controlled study. Med. Oral Patol. Oral Cir. Bucal 2012, 17, e977–e980.
26. 26- Gomes, A.O.F.; Júnior, A.S.; Noce, C.W.; Ferreira, M.; Maiolino, A.; Torres, S.R. The frequency of oral conditions detected in hematology inpatients. Hematol. Transfus. Cell Ther. 2018, 40, 240–244.