An analysis of oral microbial flora by T-RFLP in patients undergoing hematopoietic stem cell transplantation
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ORIGINAL ARTICLE
An analysis of oral microbial flora by T‑RFLP in patients undergoing hematopoietic stem cell transplantation Miho Takahashi1 · Masako Toyosaki2 · Keiko Matsui2 · Shinichiro Machida2 · Eri Kikkawa2 · Yoshihide Ota1 · Akihiro Kaneko1 · Yoshiaki Ogawa2 · Kiyoshi Ando2 · Makoto Onizuka2 Received: 30 March 2020 / Revised: 13 July 2020 / Accepted: 22 July 2020 © Japanese Society of Hematology 2020
Abstract Even though the hematopoietic stem cell transplantation (HSCT) procedure has been improved, oral mucositis (OM) is still a severe complication of the conditioning regimen. We investigated the association between OM severity and the alteration of oral bacterial flora using 16S rRNA gene-based terminal restriction fragment length polymorphism (T-RFLP) analysis in 19 consecutive patients undergoing HSCT. Oral samples were collected at pre-transplantation, at the peak of mucositis and post-engraftment. T-RFLP profiles for each timepoint were constructed into an X–Y matrix, and the distances between timepoints were calculated. Patients with severe and moderate OM had larger changes in their oral bacterial flora from before HSCT to peak of mucositis than controls (p = 0.031 and 0.016, respectively). Moreover, severe mucositis was significantly associated with an extended period of fever until engraftment, high maximum C-reactive protein levels, and prolonged periods of opioid treatment and intravenous hyper-alimentation. These findings suggest that mucositis severity is associated with the magnitude of change in the oral bacterial flora. This novel finding may help advance strategies for the prevention or treatment of OM after HSCT. Keywords Oral mucositis · T-RFLP · HSCT
Introduction Oral mucositis (OM) is one of the most severe regimenrelated toxicities causing systemic bacterial infection in immunodeficient patients undergoing hematopoietic stem cell transplantation (HSCT) [1]. OM occurs in 47–100% of individuals undergoing HSCT [2–4]. It causes appetite deficiency, difficulty in swallowing medicine and affects the activities of daily living (ADL). In patients who undergo HSCT, the barrier of the oral mucosa is broken by mucositis caused by irradiation and the conditioning regimen, and the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12185-020-02958-y) contains supplementary material, which is available to authorized users. * Makoto Onizuka [email protected] 1
Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
2
oral cavity is a port of entry for early infections [5]. A study showed that microbiologically-proven septicemia during the neutropenic phase was caused by oral microorganisms in 24 of 59 patients (41%) who underwent bone marrow transplantation [6]. As is often pointed out, oral care is very important for patients undergoing HSCT from the point of view of infection prevention. F
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