{"id":5177,"date":"2019-04-30T21:05:24","date_gmt":"2019-04-30T19:05:24","guid":{"rendered":"http:\/\/www.easistent.ro\/?p=5177"},"modified":"2019-06-21T12:51:00","modified_gmt":"2019-06-21T10:51:00","slug":"mucozita-orala-in-transplantul-autolog-de-celule-stem-pentru-tumori-solide-la-copii-comparatie-intre-procedurile-individuale-si-in-tandem","status":"publish","type":"post","link":"https:\/\/www.easistent.ro\/?p=5177","title":{"rendered":"Mucozita oral\u0103 \u00een transplantul autolog de celule stem pentru tumori solide la copii: compara\u021bie \u00eentre procedurile individuale \u0219i \u00een tandem"},"content":{"rendered":"

Autori:<\/strong>
\nOana Otilia Niculi\u021b\u0103<\/em><\/strong>
\nUniversitatea de Medicin\u0103 \u0219i Farmacie \u201cCarol Davila\u201d, Bucure\u0219ti, Rom\u00e2nia<\/em>
\nInstitutul Clinic Fundeni, Sec\u021bia Clinic\u0103 de Pediatrie, Bucure\u0219ti, Rom\u00e2nia<\/em>
\nCristina Georgiana Jercan<\/em><\/strong>
\nUniversitatea de Medicin\u0103 \u0219i Farmacie \u201cCarol Davila\u201d, Bucure\u0219ti, Rom\u00e2nia<\/em>
\nInstitutul Clinic Fundeni, Sec\u021bia Clinic\u0103 de Pediatrie, Bucure\u0219ti, Rom\u00e2nia<\/em>
\nAnca Coli\u021b\u0103<\/em><\/strong>
\nUniversitatea de Medicin\u0103 \u0219i Farmacie \u201cCarol Davila\u201d, Bucure\u0219ti, Rom\u00e2nia<\/em>
\nInstitutul Clinic Fundeni, Sec\u021bia Clinic\u0103 de Pediatrie, Bucure\u0219ti, Rom\u00e2nia<\/em><\/p>\n

 <\/p>\n

Introducere<\/strong>
\nTumorile solide reprezint\u0103 30% din toate cazurile de cancer la copii, except\u00e2nd tumorile cerebrale. Managementul tumorilor solide este complex \u0219i include: chimioterapie, interven\u021bii chirurgicale, radioterapie \u0219i, \u00een cazurile cu risc ridicat, transplant de celule stem (TCS). Mucozita oral\u0103 (MO) este cea mai frecvent\u0103 complica\u021bie la pacien\u021bii copii c\u0103rora li s-a efectuat TCS. La persoanele c\u0103rora li se face transplant, MO poate avea o evolu\u021bie pe termen lung, uneori sever\u0103.
\nAm analizat rezultatele pacien\u021bilor copii cu tumori solide \u0219i trata\u021bi cu transplant de celule stem hematopoietice (TCSH) la Institutul Clinic Fundeni, \u00eentre ianuarie 2002 \u0219i octombrie 2018 pentru a evalua durata medie a episodului de MO \u0219i a gradului de severitate conform num\u0103rului de proceduri efectuate.<\/p>\n

 <\/p>\n

Materiale \u0219i metode<\/strong>
\nAm analizat retrospectiv pacien\u021bii cu tumori solide \u0219i TCSH. Diagnosticele pacien\u021bilor: neuroblastom (NBL), tumor\u0103 cu celule germinale, sarcom Ewing, nefroblastom. Pacien\u021bii au fost \u00eemp\u0103r\u021bi\u021bi \u00een dou\u0103 grupuri: primul grup cu un singur TCSH \u0219i al doilea grup cu mai mult de un singur TCSH.
\nCriteriile utilizate pentru a evalua severitatea MO au fost, conform OMS: Gradul 1: sensibilitate \u00b1 eritem, Gradul 2: eritem, leziuni ulcerate, pacientul poate consuma alimente solide, Gradul 3: leziuni ulcerate cu eritem extins, pacientul nu poate \u00eenghi\u021bi alimente, Gradul 4: mucozit\u0103 care nu permite alimentarea.
\nTo\u021bi pacien\u021bii au realizat m\u0103suri profilactice de prevenire a MO: cur\u0103\u021barea cavit\u0103\u021bii bucale cu solu\u021bie de bicarbonat de sodiu, sp\u0103larea cavit\u0103\u021bii bucale cu ap\u0103 de gur\u0103 pe baz\u0103 de clorhexidin\u0103, spray oral cu Gel X. To\u021bi pacien\u021bii au primit profilaxie antibiotic\u0103, antiviral\u0103 \u0219i antifungic\u0103, nutri\u021bie parenteral\u0103 \u0219i tratament suportiv.
\nTo\u021bi p\u0103rin\u021bii au semnat formulare de consim\u021b\u0103m\u00e2nt informat. Am efectuat analiza statistic\u0103 utiliz\u00e2nd testul chi p\u0103trat.<\/p>\n

 <\/p>\n

Rezultate<\/strong>
\n\u00cen clinica noastr\u0103, \u00een perioada ianuarie 2002 – octombrie 2018, au fost efectuate 67 de proceduri de auto-TCSH la 52 de pacien\u021bi: 34 (65,3%) pacien\u021bi cu NBL, 9 (17,3%) pacien\u021bi cu sarcom Ewing, 6 (11,6%) pacien\u021bi cu tumor\u0103 cu celule germinale \u0219i 3 (5,8%) pacien\u021bi cu nefroblastom. Pacien\u021bii au fost \u00eemp\u0103r\u021bi\u021bi \u00een dou\u0103 grupuri: primul grup cu o singur\u0103 procedur\u0103 TCS (79% din pacien\u021bi) \u0219i al doilea grup cu mai mult dec\u00e2t o singur\u0103 procedur\u0103 TCS (21% din pacien\u021bi). Pacien\u021bii au fost diagnostica\u021bi, stadializa\u021bi \u0219i au primit tratament conform protocoalelor interna\u021bionale. Distribu\u021bia pe sexe a fost de 18 F\/34 M. Distribu\u021bia pe v\u00e2rste: 1-4 ani 38% (20 pacien\u021bi), 4-10 ani 35% (18 pacien\u021bi), > 10 ani 27% (14 pacien\u021bi). Distribu\u021bia pacien\u021bilor conform gradului de MO este reprezentat\u0103 \u00een Figura 1.
\nDurata medie a MO \u00een primul grup a fost de 6 zile (varia\u021bie de la 3 la 17 zile), \u00een vreme ce \u00een al doilea grup a fost de 13 zile (varia\u021bie de la 3 la 21 de zile). Pacien\u021bii din primul grup au primit analgezice pe o durat\u0103 medie de 7 zile, \u00een vreme ce pentru al doilea grup, perioada a fost prelungit\u0103 la 13 zile. De asemenea, pentru cel de al doilea grup am observat c\u0103 a crescut perioada de grefare, odat\u0103 cu perioada de spitalizare \u0219i m\u0103surile suportive. Pacien\u021bii cu multiple \u0219edin\u021be de chimioterapie \u0219i cu multiple spitaliz\u0103ri au prezentat risc crescut de infec\u021bie, iar pe durata celui de al doilea set de proceduri au dezvoltat diverse complica\u021bii infec\u021bioase. Pacien\u021bii din ambele grupuri s-au vindecat total de MO p\u00e2n\u0103 \u00een momentul extern\u0103rii.
\nUn singur TCSH<\/p>\n

\"mucozita\"<\/a><\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

TCSH \u00een tandem
\n\"mucozita2\"<\/a>
\n <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

Concluzie<\/strong>
\nTo\u021bi pacien\u021bii din studiul nostru au dezvoltat mucozit\u0103 oral\u0103, de\u0219i au fost luate m\u0103suri profilactice.
\nNu au fost identificate corela\u021bii \u00eentre gradul de severitate al MO \u0219i v\u00e2rsta sau sexul pacientului.
\nDurata medie a episodului de MO este mai mare la pacien\u021bii cu TCS multiple (13 zile versus 6 zile).
\nInciden\u021ba unei MO severe dup\u0103 primul TCSH a fost de 17%, \u00een vreme ce dup\u0103 TCSH \u00een tandem a fost de 69% (P<0,0001).<\/p>\n

Referin\u021be<\/strong>
\n1. Carulli G, Rocco M, Panichi A, et al. Treatment of oral mucositis in hematologic patients undergoing autologous or allogeneic transplantation of peripheral blood stem cells: a prospective, randomized study with a mouthwash containing camelia sinensis leaf extract. Hematol Rep. 2013;5(1):21-5. Published 2013 Apr 4. doi:10.4081\/hr.2013.e6
\n2. The Incidence and Severity of Oral Mucositis among Allogeneic Hematopoietic Stem Cell Transplantation Patients: A Systematic Review Chaudhry, Hafsa M. et al, Biology of Blood and Marrow Transplantation , Volume 22 , Issue 4 , 605 – 616
\n3. Staudenmaier, T., Cenzer, I., Crispin, A. et al. Support Care Cancer (2018) 26: 1577. https:\/\/doi.org\/10.1007\/s00520-017-4000-5
\n4. Gabriel, Don & Shea, Thomas & Olajida, Oludamilola & Serody, Jonathan & Comeau, Terrance. (2004). The Effect of Oral Mucositis on Morbidity and Mortality in Bone Marrow Transplant. Seminars in oncology. 30. 76-83. 10.1053\/j.seminoncol.2003.11.040.
\nContact<\/p>\n

motilia24@yahoo.com<\/p>\n

 <\/p>\n

 <\/p>\n

Oral mucositis in autologous stem cell transplantation for solid tumors in children: comparison between single and tandem procedures<\/b><\/strong><\/p>\n

 <\/p>\n

Authors:<\/strong><\/p>\n

Oana Otilia Niculi\u021b\u0103<\/strong>
\n1. „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
\n2. Fundeni Clinical Institute, Pediatric BMT Dept., Bucharest, Romania<\/p>\n

Cristina Georgiana Jercan<\/strong>
\n1. „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
\n2. Fundeni Clinical Institute, Pediatric BMT Dept., Bucharest, Romania<\/p>\n

Anca Coli\u021b\u0103<\/strong>
\n1. „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
\n2. Fundeni Clinical Institute, Pediatric BMT Dept., Bucharest, Romania<\/p>\n

Background<\/strong><\/p>\n

Solid tumors represent 30% of all pediatric cancers, excepting brain tumors. The management of solid tumours is complex and includes chemotherapy, surgery, radiotherapy and, in high-risk cases, stem cell transplantation (SCT). Oral mucositis (OM) is the most frequent complication of pediatric patients undergoing SCT. In transplant recipients OM can have long-term evolution, sometimes severe.
\nWe analyzed the results of pediatric patients with solid tumours and HSCT treated in Fundeni Clinical Institute between January 2002 and October 2018 to evaluate the median duration of OM episode and grade of severity according to the numbers of procedures performed.<\/p>\n

Matherials and methods<\/strong><\/p>\n

We retrospectively analyzed patients with solid tumours and HSCT. Patients diagnosis: neuroblastoma (NBL), germ-cell tumour (GCT), Ewing sarcoma, nefroblastoma. Patients were divided into 2 groups: first group with one HSCT and second groupwith more than one HSCT.
\nCriteria used to asess severity of OM were, according to WHO: Grade 1 \u2013 soreness \u00b1 erythema, Grade 2 – erythema, ulcers; patient can swallow solid food, Grade 3 – ulcers with extensive erythema; patient cannot swallow food, Grade 4 – mucositis to the extent that alimentation is not possible.
\nAll patients performed prophylactic measurements to prevent OM : mouth cleansing with sodium bicarbonate solution, mouthwash with clorhexidine, oral spray with Gel X. All patients received antibiotic, antiviral and antifungal prophylaxis, parenteral nutrition and supportive treatment.
\nAll parents signed informed consent forms. We performed the statistical analysis using chi square test.<\/p>\n

Results<\/strong><\/p>\n

In our clinic, between January 2002 and October 2018, were performed 67 auto-HSCT procedures to 52 patients: 34 (65.3%) pts with NBL, 9 (17.3%) pts with ES, 6 (11.6%) pts with GCT and 3 (5.8%) pts with nefroblastoma. Patients were divided into 2 groups: first group with a single SCT procedure (79% of pts) and second group with more than one SCT procedure (21% of pts). Patients were diagnosed, staged and received treatment according to international protocols. Sex ratio was 18F\/34M. Age distribution:1-4 y 38% (20 pts), 4-10 y 35% (18 pts), > 10 y 27% (14 pts). Distribution of patients according to grade of OM is represented in Figure 1. The median duration of OM in the first group was 6 days (range 3 to 17 days), while in the second group was 13 days (range 3 to 21 days). For the first group patients received pain medication for an average of 7 days, whereas for the second group the period increased to 13 days. Also, for the second group we noticed the engraftment period increased, along with the hospitalization and supportive measures. Patients with multiple courses of chemotherapy and with multiple hospitalizations presented increased infectious risk and during the second procedures developed various infectious complications. Patients from both groups presented full recovery of oral mucositis by the time they were discharged.<\/p>\n

Conclusion<\/strong><\/p>\n

All patients in our study have developed oral mucositis, though prohylaxis measurements have been used. We did not find corelations between the severity of OM and age or sex of patients.
\nThe median duration of OM episode is increased in patients with multiple SCT (13 days versus 6 days) .
\nThe incidence of severe OM after the first HSCT was 17%, whereas after tandem HSCT was 69% (P<0,0001).<\/p>\n

References<\/strong>
\n1.\u00a0\u00a0 \u00a0Carulli G, Rocco M, Panichi A, et al. Treatment of oral mucositis in hematologic patients undergoing autologous or allogeneic transplantation of peripheral blood stem cells: a prospective, randomized study with a mouthwash containing camelia sinensis leaf extract. Hematol Rep. 2013;5(1):21-5. Published 2013 Apr 4. doi:10.4081\/hr.2013.e6
\n2.\u00a0\u00a0 \u00a0The Incidence and Severity of Oral Mucositis among Allogeneic Hematopoietic Stem Cell Transplantation Patients: A Systematic Review Chaudhry, Hafsa M. et al, Biology of Blood and Marrow Transplantation , Volume 22 , Issue 4 , 605 – 616
\n3.\u00a0\u00a0 \u00a0Staudenmaier, T., Cenzer, I., Crispin, A. et al. Support Care Cancer (2018) 26: 1577. https:\/\/doi.org\/10.1007\/s00520-017-4000-5
\n4.\u00a0\u00a0 \u00a0Gabriel, Don & Shea, Thomas & Olajida, Oludamilola & Serody, Jonathan & Comeau, Terrance. (2004). The Effect of Oral Mucositis on Morbidity and Mortality in Bone Marrow Transplant. Seminars in oncology. 30. 76-83. 10.1053\/j.seminoncol.2003.11.040.
\nContact<\/p>\n

motilia24@yahoo.com<\/p>\n

 <\/p>\n

Descarcare documente:<\/p>\n

Romana<\/a><\/p>\n

Engleza<\/a><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Autori: Oana Otilia Niculi\u021b\u0103 Universitatea de Medicin\u0103 \u0219i Farmacie \u201cCarol Davila\u201d, Bucure\u0219ti, Rom\u00e2nia Institutul Clinic Fundeni, Sec\u021bia Clinic\u0103 de Pediatrie, Bucure\u0219ti, Rom\u00e2nia Cristina Georgiana Jercan Universitatea de Medicin\u0103 \u0219i Farmacie \u201cCarol Davila\u201d, Bucure\u0219ti, Rom\u00e2nia Institutul Clinic Fundeni, Sec\u021bia Clinic\u0103 de Pediatrie, Bucure\u0219ti, Rom\u00e2nia Anca Coli\u021b\u0103 Universitatea de Medicin\u0103 \u0219i Farmacie \u201cCarol Davila\u201d, Bucure\u0219ti, Rom\u00e2nia Institutul […]<\/p>\n","protected":false},"author":3,"featured_media":5179,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[152,155],"tags":[],"_links":{"self":[{"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/posts\/5177"}],"collection":[{"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5177"}],"version-history":[{"count":6,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/posts\/5177\/revisions"}],"predecessor-version":[{"id":5250,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/posts\/5177\/revisions\/5250"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/media\/5179"}],"wp:attachment":[{"href":"https:\/\/www.easistent.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5177"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5177"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5177"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}