Longitudinal assessment of immunological and oral clinical conditions in patients undergoing anticancer treatment for leukemia Erika Barbara Abreu Fonseca Thomaz a, *, Jose ´ Carlos Elias Mouchrek Jr. b , Adriana Quinzeiro Silva c , Rosane Nassar Meireles Guerra d , Silvana Amado Libe ´ rio e , Maria Carmen Fontoura Nogueira da Cruz e , Anto ˆnio Luı ´s Amaral Pereira e a Department of Public Health, Federal University from Maranha ˜o, Sa˜o Luı´s, MA, Brazil b Department of Dentistry, University Center from Maranha ˜o, Sa ˜o Luı´s, MA, Brazil c University Center from Maranha˜o, Sa˜o Luı´s, MA, Brazil d Department of Biochemistry, Federal University from Maranha ˜o, Sa˜o Luı´s, MA, Brazil e Department of Dentistry, Federal University from Maranha ˜o, Sa˜o Luı´s, MA, Brazil 1. Introduction Cancer shows a high incidence and continues to be one of the leading causes of death in the world [1]. In childhood cancer is emerging as a major cause of death in Asia, Central and South America, Northwest Africa, and the Middle East, where fewer children are now dying from preventable infectious diseases [2–5]. Acute lymphoid leukemia (ALL) is the most common type of pediatric cancer [4,6], accounting for nearly 25–35% of all pediatric cancers [1,7,8]. Among the treatment modalities for ALL, chemotherapy (Ct) and bone marrow transplantation (BMT) are the most frequent [9,10]. However, the disease and the antineoplastic treatment for leukemia (ATL) have various side effects [11–13]. In the oral cavity, these manifestations include mucositis, xerostomia, dental caries, gingival bleeding, candidiasis, labial herpes, stomatitis aphthosa, angular cheilitis and other [14–24]. Mucosistis, xerostomia, dental caries and gingivitis are some of the most frequent [14,17,18,25]. However, the documentation of the ATL’s side effects in oral health is specially based on case reports [19,23], literature review [16,21,26], sectional studies [15,17,24], or with no International Journal of Pediatric Otorhinolaryngology 77 (2013) 1088–1093 A R T I C L E I N F O Article history: Received 14 February 2013 Received in revised form 27 March 2013 Accepted 28 March 2013 Available online 10 May 2013 Keywords: Neoplasms Leukemia Mouth diseases Drug therapy Longitudinal studies A B S T R A C T Objective: The aim of this study was to evaluate the evolution of the immunological and oral clinical conditions of children and adolescents undergoing anticancer treatment for leukemia (ATL). Methods: Twenty patients aged 3–15 years undergoing chemotherapy seen at a referral center for cancer treatment in the State of Maranha ˜o, Brazil, from 2008 to 2009, were evaluated at baseline (1st). Twenty- two controls were selected in public schools. Oral lesions, caries experience (deft and DMFT), plaque index (PI), gingival index (GI) and salivary IgA were analyzed. Patients and controls were evaluated after 6 months (2nd). The Shapiro Wilk, Mann–Whitney, Wilkoxon and Spearman correlation tests were carried out (alpha = 5%). Results: Gingivitis and mucositis were the most frequent manifestations in oral mucosae during the two phases. The mean DMFT index increased from 3.9  4.2 (1st) to 4.4  4.3 (2nd) (p = 0.04). The mean deft index was the same in the 1st (1.9  2.7) and 2nd (1.9  2.7) evaluation (p = 0.86). The GI also did not vary between assessments: 1st (1.3  0.4) and 2nd (1.3  0.3) – (p = 0.12), except on the lingual and distal surfaces, where increased from the 1st to 2nd evaluation (p < 0.01). The PI varied from 0.9 to 1.1, but this difference was not significant (p = 0.48), except for the lingual surface, where increased from 0.6 to 1.0 (p = 0.04). There was a reduction in salivary IgA levels from 2.9 to 1.9 mg/mL (p = 0.04), and mean IgA was significantly higher in the control group (5.4 mg/mL) if compared to cases (p < 0.01). Conclusion: The clinical and immunological oral conditions of children and adolescents undergoing ATL presented an unfavorable evolution. This study highlights the need for monitoring oral conditions during the ATL and draws attention to the additional responsibility of the otolaryngologist in referring ATL patients to the dentist, especially in the presence of clinical evidence of oral problems. We suggest that the planning of ATL take into account the oral health, in a multidisciplinary oncology team. ß 2013 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Rua Bara ˜o de Itapary, 155, Centro, Sa ˜o Luı ´s, Maranha ˜o CEP: 65020-070, Brazil. Tel.: +55 98 3272 9678. E-mail address: ebthomaz@globo.com (Thomaz). Contents lists available at SciVerse ScienceDirect International Journal of Pediatric Otorhinolaryngology jo ur n al ho m ep ag e: ww w.els evier .c om /lo cat e/ijp o r l 0165-5876/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijporl.2013.03.037