Subjective Oral Dryness following Hematopoietic Cell Transplantation: A Report from the Orastem Study

Marjolein S. Bulthuis*, Stephanie J.M. van Leeuwen, Renske Z. Thomas, Lucky L.A. van Gennip, Heidi M. Whiteside, Scott Isom, David M. Kline, Alexa M.G.A. Laheij, Judith E. Raber-Durlacher, Bengt Hasséus, Jan Erik Johansson, Allan J. Hovan, Michael T. Brennan, Inger von Bültzingslöwen, Marie Charlotte D.N.J.M. Huysmans, Nicole M.A. Blijlevens

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Xerostomia, or subjective oral dryness, is a serious complaint after hematopoietic cell transplantation (HCT). Xerostomia is rated as one of the most bothersome symptoms by HCT recipients, negatively affecting quality of life. This substudy of the Orastem study, a prospective longitudinal, international, observational, multicenter study, aimed to describe the prevalence and severity of xerostomia following HCT. Furthermore, the effect of the conditioning regimen, type of transplantation, and oral mucosal changes related to chronic graft-versus-host disease (cGVHD) in the development of xerostomia were studied. All HCT recipients rated xerostomia on a scale of 0 to 10 before the conditioning regimen, several times early post-HCT, and at 3 months post-HCT, and only allogeneic HCT recipients also rated xerostomia at 6 and 12 months post-HCT. In addition, stimulated whole mouth saliva was collected several times. Linear regression models and longitudinal mixed-effects models were created to investigate the influence of risk indicators on xerostomia. A total of 99 autologous and 163 allogeneic HCT recipients were included from 6 study sites in Sweden, Canada, the Netherlands, and the United States. The prevalence of xerostomia was 40% before the conditioning regimen, 87% early post-HCT, and 64% at 3 months post-HCT. Complaints after autologous HCT were transient in nature, while the severity of xerostomia in allogeneic HCT recipients remained elevated at 12 months post-HCT. Compared to autologous HCT recipients, allogeneic HCT recipients experienced 1.0 point more xerostomia (95% confidence interval [CI], .1 to 2.0) early post-HCT and 1.7 points more (95% CI, .4 to 3.0) at 3 months post-HCT. Allogeneic HCT recipients receiving a high-intensity conditioning regimen experienced more xerostomia compared to those receiving a nonmyeloablative or reduced-intensity conditioning regimen. The difference was 2.0 points (95% CI, 1.1 to 2.9) early post-HCT, 1.8 points (95% CI, .3 to 3.3) after 3 months, and 1.7 points (95% CI, .0 to 3.3) after 12 months. Total body irradiation as part of the conditioning regimen and oral mucosal changes related to cGVHD did not significantly influence the severity of xerostomia. Conditioning regimen intensity was a significant risk indicator in the development of xerostomia, whereas total body irradiation was not. Allogeneic HCT recipients experienced more xerostomia than autologous HCT recipients, a difference that cannot be explained by a reduction in stimulated salivary flow rate or the development of oral mucosal changes related to cGVHD.

Original languageEnglish
Pages (from-to)446.e1-446.e11
Number of pages11
JournalTransplantation and Cellular Therapy
Volume30
Issue number4
Early online date17 Jan 2024
DOIs
Publication statusPublished - Apr 2024

Bibliographical note

Publisher Copyright:
© 2024 The American Society for Transplantation and Cellular Therapy

Funding

Financial disclosure: The study was partially funded by the Dutch Cancer Society (ACTA 2014-7468).

FundersFunder number
KWF KankerbestrijdingACTA 2014-7468
KWF Kankerbestrijding

    Keywords

    • Hematopoietic cell transplantation
    • Mouth dryness
    • Xerostomia

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