FREDERICO LUIZ DULLEY
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conferenceObject Oral leukoplakia in chronic graft versus host disease(2012) PAVESI, V. C. S.; FRANCA, C. M.; CASTELLI, J. B.; SABOYA, R.; DULLEY, F. L.; CORACIN, F. L.Introduction: Late complications of allogeneic hematopoietic stem cell transplantation (HSCT) include a risk of secondary malignancies and early diagnosis of oral premalignant or malignant lesions requires an assessment of potential predisposing risk factors. Patients with oral epithelial dysplasia after allogeneic HSCT include oral cGVHD as a potential risk factor for oral cancer. A better understanding of the clinical features and potential factors associated with secondary oral cancer, may be benefit predicting and identifying this late complication of allogeneic HSCT. Case details: A 37 years old male who had received an allogeneic hematopoietic stem cell transplantation in October/2002 was referred to a Oral Medicine Outpatient in August 2011 with a white-plaque lesion of the oral mucosa the conditioning regimen to HSCT comprised busulfan-melphalan and graft-versus-host disease prophylaxis was cyclosporine-methotrexate. The patient developed lichenoid-oral cGVHD around day 60 and treatment comprised corticosteroid-cyclosporine. Clinical examination revealeda non-symptomatic 2 cm white-plaque of the hard palate. Exfoliative cytology was performed and no atypical cells were seen. The lesion increased in size to 4 cm long during the next 10-days. An incisional biopsy was undertaken and histopathological analysis revealed an epithelial tissue with acanthosis, hypergranulosis, hyperkeratosis, papilomatosis and apoptosis plus lymphocyte exocitosis. No atypical, cell dysplasia or koylocites were present. Mild to moderate cGVHD activity was seen. In this case, the patient was monitored in our outpatient program and no changes were noted in the lesion. Conclusion: The associationbetweenchronic graftversus host disease andoralsquamous cell carcinoma suggests a close monitoring of patients for early diagnosis of possible secondaryneoplasmsanddemonstratestheaggressivebehaviourofthislatecomplication. Relevance: Due to this aggressive behaviour and the increase number of HSCT worldwide, careful long-term follow-up by a cancer team, including oral medicine expertise, is recommended, and patients should be aware of cancer risk.- Bone marrow transplantation and acute myeloid leukemia: Brazilian guidelines(2013) SILLA, Lucia Mariano da Rocha; DULLEY, Frederico; SABOYA, Rosaura; PATON, Eduardo; KERBAUY, Fabio; ARANTES, Adriano de Moraes; HAMERSCHLAK, Nelson
conferenceObject Patients oral conditions before hematopoietic stem-cell transplantation in Brazil(2012) CORACIN, F. L.; SOARES JUNIOR, L. A. V.; DULLEY, F. L.; SABOYA, R.; SILVA-SANTOS, P. S. da; TINOCO-ARAUJO, J. E.; COLTURATO, V. A. R.; ANTUNES, H. S.; FERREIRA, C. G.; BOUZAS, L. F. S.; PEREIRA, S. C. M.; MONTEIRO, M. C. P.; RAMPINI, M. P.; MAYHE, R.; LIME, E. M.; TANIMOTO, H. M.; PATON, E. J. A.; SILVA, G. B. L.; SACONO, N. T.; BATISTA, A. C.; BARIANI, C.; PERES, M. P. S. M.Objectives: This prospective multicenter study aims to conduct an epidemiologic survey of oral health status of the patients waiting for the hematopoietic stem cell transplantation (HSCT) in five Brazilian Centers to identify oral needs prior to HSCT. Methods: Patients enrolled in this study were submitted to a dental clinical evaluation whilst they were awaiting for HSCT, performed by a dentist from the participating Institution. Demographic and medical data were collated together with, gingival (GI) and plaque (PI) indexes and index of decay missed and filled teeth (DMFT) were evaluated. These indexes are indicators of oral health according to the World Health Organization (WHO). Results: During the period between April 2011 and April 2012, 101 (73 male and 48 female) patients were enrolled in this prospective study at five HSCT Brazilian Centers. Underlying diseases comprised 25 multiple myeloma, 24 non-Hodgkin lymphoma, 19 acute lymphoblastic leukemia, 16 acute myelogenous leukemia, 13 severe aplastic anemia, 11 Hodgkin lymphoma, six chronic myelogenous leukemia, three myelodisplastic syndrome, one testicular tumor, one retinoblastoma, one myelofibrosis and one chronic lymphoblastic leukemia. Median age was 40 years (range: 4–67). At the time of the survey, patients presented mean GI = 0.8, mean PI = 1.2. DMFT index were evaluated in 104/121 patients and showed mean of 16.1. Conclusion: Patients undergoing HSCT need comprehensive oral care in Brazil due a poor oral health at the time of transplantation, to avoid possible infections secondary to myelosuppression and mucosal barrier injury. Relevance: The patients’ status prior-HSCT may to lead to protocols of dental treatment before HSCT suggesting an important role in the maintenance of oral integrity. Prior dental intervention can lead a better quality of life and improve the results of transplantation, reducing time of mucositis and infections.conferenceObject Ciclosporine-induced fibrovascular polyps in the tongue(2012) TORRES-PEREIRA, C.; SABOYA, R.; CASTELLI, J. B.; ROCHA, A. C.; ROCHA, G. B. L.; BONFIM, C. S.; DULLEY, F. L.; CORACIN, F. L.Introduction: Cyclosporine (CsA) is used for chronic graft-versus-host disease (cGVHD) treatment and can lead to increased or synthesis of collagen and fibrous eposition. Gingival overgrowth is a common adverse effect of CsA, however it is rarely seen in patients using CsA for treatment of cGVHD. The development of CsA- associated nongingival growth is rare and represents polyps of granulation/fibrous tissue. These lesions have been referred as oral inflammatory polyps that may be aggravated in the presence of cGVHD. Case details: A 6 year old male with Fanconi Anemia underwent an unrelated hematopoietic stem-cell transplantation (HSCT) in March/2007. cGVHD was diagnosed in skin and oral mucosa and was treated with cyclosporine and corticosteroids. In August 2008 the patient was referred to the Oral Medicine Service for evaluation of a 3 cm growing polyps in the border of the tongue. Incisional biopsy was performed and revealed fibrous-vascular hyperplasia. While the patient waited for an excisional biopsy, the polyps increased in size to 10 cm. This biopsy revealed the same histopathological characteristic. In May 2011 the patient presented with other polyps of the middle side of tongue associated with other small nodules. These lesions were completely removed and again the diagnosis of fibrous-vascular hyperplasia was given immunohistochemistry examination revealed negativity to anti-cytomegalovirus (CMV)/anti-herpesvirus (HSV) and Ki-67 expression showed moderate to strong staining. No atypical cells were observed. Conclusions: Although it is an unusual reported lesion, fibrous-vascular polyps are a recent described pathological entity associated with the use of CsA. These lesions should be considered as a differential diagnosis of oral masses in post HSCT Fanconi Anemia patients, particularly to exclude malignancies in this high risk group of individuals. Relevance: Fanconi anaemia patients need to be closely monitored due to a high prevalence of secondary malignancies.- Analysis of the feasibility of early hospital discharge after autologous hematopoietic stem cell transplantation and the implications to nursing care(2014) BARBAN, Alessandra; CORACIN, Fabio Luiz; MUSQUEIRA, Priscila Tavares; BARBAN, Andrea; RUIZ, Lilian Piron; RUIZ, Milton Artur; SABOYA, Rosaura; DULLEY, Frederico LuizINTRODUCTION: Autologous hematopoietic stem cell transplantation is a conduct used to treat some hematologic diseases and to consolidate the treatment of others. In the field of nursing, the few published scientific studies on nursing care and early hospital discharge of transplant patients are deficient. Knowledge about the diseases treated using hematopoietic stem cell transplantation, providing guidance to patients and caregivers and patient monitoring are important nursing activities in this process. Guidance may contribute to long-term goals through patients' short-term needs. AIM: To analyze the results of early hospital discharge on the treatment of patients submitted to autologous transplantation and the influence of nursing care on this conduct. METHODS: A retrospective, quantitative, descriptive and transversal study was conducted. The hospital records of 112 consecutive patients submitted to autologous transplantation in the period from January to December 2009 were revisited. Of these, 12 patients, who remained in hospital for more than ten days after transplantation, were excluded from the study. RESULTS: The medical records of 100 patients with a median age of 48.5 years (19-69 years) were analyzed. All patients were mobilized and hematopoietic stem cells were collected by leukapheresis. The most common conditioning regimes were BU12Mel100 and BEAM 400. Toxicity during conditioning was easily managed in the outpatient clinic. Gastrointestinal toxicity, mostly Grades I and II, was seen in 69% of the patients, 62% of patients had diarrhea, 61% of the patients had nausea and vomiting and 58% had Grade I and II mucositis. Ten patients required hospitalization due to the conditioning regimen. Febrile neutropenia was seen in 58% of patients. Two patients died before Day +60 due to infections, one with aplasia. The median times to granulocyte and platelet engraftment were 12 days and 15 days, respectively, with median red blood cell and platelet transfusions until discharge of three and four units, respectively. Twenty-three patients required rehospitalization before being discharged from the outpatient clinic. CONCLUSION: The median time to granulocyte engraftment was 12 days and during the aplasia phase few patients were hospitalized or suffered infections. The toxicity of the conditioning was the leading cause of rehospitalization. The nursing staff participated by providing guidance to patients and during the mobilization, transplant and outpatient follow-up phases, thus helping to successfully manage toxicity.
- Oral health as a predictive factor for oral mucositis(2013) CORACIN, Fabio Luiz; SANTOS, Paulo Sergio da Silva; GALLOTTINI, Marina H. C.; SABOYA, Rosaura; MUSQUEIRA, Priscila Tavares; BARBAN, Alessandra; CHAMONE, Dalton de Alencar Fischer; DULLEY, Frederico Luiz; NUNES, Fabio DaumasOBJECTIVES: Oral mucositis is a complication frequently associated with hematopoietic stem cell transplantation, decreasing a patient's quality of life and increasing the occurrence of opportunistic infections. The purpose of this study was to determine the incidence and severity of oral mucositis and to assess the correlation of this disease with the oral health of an individual at the time of hematopoietic stem cell transplantation. METHODS: Before transplantation, patients' oral health and inflammatory conditions were determined using the gingival index and the plaque index, which are based on gingival bleeding and the presence of dental plaque, respectively. Additionally, the dental health status was determined using the decayed, missing, and filled teeth index. The monitoring of oral mucositis was based on the World Health Organization grading system and was performed for five periods: from Day 0 to D+5, from D+6 to D+10, from D+11 to D+15, from D+16 to D+20, and from D+21 to D+30. RESULTS: A total of 97 patients (56% male and 44% female) who underwent hematopoietic stem cell transplantation at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo between January 2008 and July 2009 were prospectively examined. The incidence of ulcerative mucositis was highest from days +6 to +10 and from days +11 to +15 in the patients who underwent autologous and allogeneic hematopoietic stem cell transplantation, respectively. CONCLUSION: The data, including the dental plaque and periodontal status data, showed that these oral health factors were predictive of the incidence and severity of oral mucositis in a cohort of patients with similar conditioning regimens before hematopoietic stem cell transplantation.
bookPart Transplante de células-tronco hematopoiéticas(2013) DULLEY, Frederico Luiz; SABOYA, Rosaura