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Herpesviruses and oral ulcerations in hematopoietic SCT recipients

Bone Marrow Transplantation volume 48, pages 1364–1365 (2013)Cite this article

We have read with great interest an article by van der Beek et al.1 published in Bone Marrow Transplantation. The authors reported that HSV-1 shedding in oral fluid after hematopoietic SCT (HSCT) is a significant predictor for oral mucosal ulcerations in adult patients, thus being a promising marker of the epithelial lesion. However, the conditioning regimen proved to be a non-significant predictor of ulcerative mucositis (UM) in this study. Therefore, we would like to discuss some interrelations between intensity of conditioning therapy, viremia rates and UM frequency in our pediatric setting. Some of these cases were reported elsewhere.2 Our study involved 120 patients of 1–21 years old (a mean of 12.4±5.9), comprising 56% males and 44% females, treated at R. Gorbacheva Memorial Institute of Children Hematology and Transplantology from 2002 to 2010. The patients with oncohematological disorders (mostly, acute leukemias, 73% of the total) underwent allo-HSCT from HLA-matched related or unrelated donors (38% and 62% of total group, respectively). The patients received peripheral blood stem cells or BM (60% and 40% of the total, respectively). Sixty-one recipients (51%) underwent myeloablative conditioning treatment (basically, BuCy protocols), while other patients were subjected to reduced-intensity conditioning (RIC), mostly, fludarabine-based treatment. GVHD prophylaxis was performed with CYA and MTX, at a standard schedule. In non-related HSCTs, antilymphocyte globulin treatment was added in 91 cases (76%), at 20 mg/m2 daily. Acyclovir prophylaxis since day 0 was performed in 31 patients (26% of total).

To assess the degree of mucosal lesions, we used a WHO Oral Mucositis scale. Grade 1 corresponded to soreness and visible erythema, whereas grades 2–4 designated less or more severe mucosal ulcerations that caused feeding disability. Clinical mucositis grading was performed from day −5 to day +60 post-HSCT. Peak scores were determined and taken for statistical evaluation.3 Within this time period, 18 patients (15%) did not exhibit any oral mucosal ulcers (grade 0–1), whereas ulceration (UM grades 2–4) were registered in 44 (37%), 35 (29%) and 23 cases (19%), respectively. The entire study protocol was approved by the Institutional Review Board on Medical Ethics at the St. Petersburg State I. Pavlov Medical University. All patients gave their written informed consent, according to the Declaration of Helsinki.

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Authors and Affiliations

  1. R.M.Gorbacheva Memorial Institute of Children Hematology and Transplantology, St. Petersburg State I. Pavlov Medical University, St. Petersburg, Russia

    O S Pankratova, S N Shiryaev, V N Vavilov, L S Zubarovskaya & B V Afanasyev

  2. Department of Clinical and Laboratory Diagnostics, St. Petersburg State I. Pavlov Medical University, St. Petersburg, Russia

    A B Chukhlovin & Y A Eismont

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  1. O S Pankratova
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  2. A B Chukhlovin
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  3. S N Shiryaev
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  5. V N Vavilov
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Correspondence to A B Chukhlovin.

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Pankratova, O., Chukhlovin, A., Shiryaev, S. et al. Herpesviruses and oral ulcerations in hematopoietic SCT recipients. Bone Marrow Transplant 48, 1364–1365 (2013). https://doi.org/10.1038/bmt.2013.74

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