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Febrile neutropenia and periodontitis: lessons from a case periodontal treatment in the intervals between chemotherapy cycles for leukemia reduced febrile neutropenia

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Abstract

Goals of work

Oral and systemic infections arising from the oral cavity are significant problems in clinical management of patients undergoing leukemia treatment. However, there is significant disparity in the reported incidences of development of periodontal infections. Evidence is limited to those showing the systemic influence of periodontal infection in neutropenic patients. This study indicated an association between febrile neutropenia (FN) and periodontitis in a case in which periodontal treatment in the intervals between chemotherapy cycles reduced FN in subsequent courses of chemotherapy and hematopoietic transplantation (HCT).

Materials and methods

Periodontal treatment was performed in a 61-year-old man with advanced periodontitis, who received HCT following three cycles of chemotherapy. After recovery from neutropenia induced by initial chemotherapy, periodontal treatment was performed in each chemotherapy interval period. Following extraction of teeth with severe advanced periodontitis, all teeth were subjected to periodontal pocket curettage and root planning, which are common periodontal treatments to reduce periodontal pockets harboring anaerobic periodontal bacteria, before HCT.

Main results

Periodontal treatment successfully reduced periodontal pockets from 4.1 ± 1.5 mm to 3.0 ± 0.6 mm, which was almost within the healthy range (<3.0 mm), before HCT. The frequency of FN decreased significantly with increasing cycles of chemotherapy, and decreases in FN corresponded to progress of periodontal treatment. Blood cultures obtained a total of 12 times throughout leukemia treatment were all negative.

Conclusions

The observations reported here indicate the importance of periodontal treatment in clinical management of patients undergoing leukemia treatment to prevent FN, although all blood cultures were negative.

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References

  1. Estey E, Dohner H (2006) Acute myeloid leukemia. Lancet 368:1894–1907

    Article  PubMed  Google Scholar 

  2. Greenberg MS, Cohen SG, McKitrick JC, Cassileth PA (1982) The oral flor as a source of septicemia in patients with acute leukemia. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endodontology 53:32–36

    CAS  Google Scholar 

  3. Greer JP, Baer MR, Kinney MC (2004) Acute myeloid leukemia in adults. In: Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraskevas F, Glader B (eds) Wintrobe’s clinical hematology. Lippincott Williams & Wilkins, Philadelphia, PA, pp 2097–2142

    Google Scholar 

  4. Heimdahl A (1999) Prevention and management of oral infections in cancer patients. Support Care Cancer 7:224–228

    Article  PubMed  CAS  Google Scholar 

  5. Laine PO, Lindqvist JC, Pyrhonen SO, Strand-Pettinen IM, Teerenhovi LM, Meurman JH (1992) Oral infection as a reason for febrile episodes in lymphoma patients receiving cytostatic drugs. Eur J Cancer Part B Oral Oncol 28B:103–107

    Article  CAS  Google Scholar 

  6. Masaoka T (2004) Evidence-based recommendations for antimicrobial use in febrile neutropenia in Japan: executive summary. Clin Infect Dis 39(Suppl 1):S49–S52

    Article  PubMed  Google Scholar 

  7. Overholser CD, Peterson DE, Williams LT, Schimpff SC (1982) Periodontal infection in patients with acute nonlymphocyte leukemia. Prevalence of acute exacerbations. Archives of Internal Medicine 142:551–554

    Article  CAS  Google Scholar 

  8. Peterson DE, Minah GE, Reynolds MA, Weikel DS, Overholser CD, DePaola LG, Wade JC, Suzuki JB (1990) Effect of granulocytopenia on oral microbial relationships in patients with acute leukemia. Oral Surg Oral Med Oral Pathol 70:720–723

    Article  PubMed  CAS  Google Scholar 

  9. Peterson DE, Overholser CD (1981) Increased morbidity associated with oral infection in patients with acute nonlymphocytic leukemia. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endodontology 51:390–393

    CAS  Google Scholar 

  10. Raber-Durlacher JE, Epstein JB, Raber J, van Dissel JT, van Winkelhoff AJ, Guiot HF, van der Velden U (2002) Periodontal infection in cancer patients treated with high-dose chemotherapy. Support Care Cancer 10:466–473

    Article  PubMed  Google Scholar 

  11. Reynolds MA, Minah GE, Peterson DE, Weikel DS, Williams LT, Overholser CD, DePaola LG, Suzuki JB (1989) Periodontal disease and oral microbial successions during myelosuppressive cancer chemotherapy. J Clin Periodontol 16:185–189

    Article  PubMed  CAS  Google Scholar 

  12. Sutton RB, Smales FC (1983) Cross-sectional study of the effects of immunosuppressive drugs on chronic periodontal disease in man. J Clin Periodontol 10:317–326

    Article  PubMed  CAS  Google Scholar 

  13. Toljanic JA, Bedard JF, Larson RA, Fox JP (1999) A prospective pilot study to evaluate a new dental assessment and treatment paradigm for patients scheduled to undergo intensive chemotherapy for cancer. Cancer 85:1843–1848

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This study was supported by a Grant-in-Aid for Young Scientists (Start-up) (20890138) from the Japan Society for the Promotion of Science.

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Author notes

  1. Fumihiko Ishimaru

    Present address: Okayama Red Cross Blood Center, Okayama, Japan

  2. Fusanori Nishimura

    Present address: Department of Dental Science for Health Promotion, Division of Cervico-Gnathostomatology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan

Authors and Affiliations

  1. Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8525, Japan

    Yoshihiko Soga, Chieko Kudo, Kaori Matsuura-Yoshimoto, Kokoro Yamabe, Yuko Sugiura, Fusanori Nishimura & Shogo Takashiba

  2. Dental Section of Perioperative Management Center, Okayama University Hospital of Medicine and Dentistry, Okayama, Japan

    Yoshihiko Soga

  3. Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Yoshiko Yamasuji, Yoshinobu Maeda, Fumihiko Ishimaru & Mitsune Tanimoto

Authors
  1. Yoshihiko Soga
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  2. Yoshiko Yamasuji
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  3. Chieko Kudo
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  6. Yuko Sugiura
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  7. Yoshinobu Maeda
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  8. Fumihiko Ishimaru
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  11. Shogo Takashiba
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Corresponding author

Correspondence to Shogo Takashiba.

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Soga, Y., Yamasuji, Y., Kudo, C. et al. Febrile neutropenia and periodontitis: lessons from a case periodontal treatment in the intervals between chemotherapy cycles for leukemia reduced febrile neutropenia. Support Care Cancer 17, 581–587 (2009). https://doi.org/10.1007/s00520-008-0532-z

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  • DOI: https://doi.org/10.1007/s00520-008-0532-z

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