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

• Published in: Transplantation and cellular therapy 2024-04, Vol.30 (4), p.446.e1-446.e11
• Main Authors: Bulthuis, Marjolein S., van Leeuwen, Stephanie J.M., Thomas, Renske Z., van Gennip, Lucky L.A., Whiteside, Heidi M., Isom, Scott, Kline, David M., Laheij, Alexa M.G.A., Raber-Durlacher, Judith E., Hasséus, Bengt, Johansson, Jan-Erik, Hovan, Allan J., Brennan, Michael T., von Bültzingslöwen, Inger, Huysmans, Marie-Charlotte D.N.J.M., Blijlevens, Nicole M.A.
• Format: Article
• Language: English
• Subjects: Graft vs Host Disease - epidemiology; Graft vs Host Disease - etiology; Hematologi; Hematology; Hematopoietic cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Mouth dryness; Prospective Studies; Quality of Life; Transplantation, Homologous - adverse effects; United States; Xerostomia; Xerostomia - epidemiology; Xerostomia - etiology
• ISSN: 2666-6367; 2666-6375; 2666-6367
• DOI: 10.1016/j.jtct.2024.01.067

•Orastem is a prospective longitudinal international observational multicenter study.•The majority of hematopoietic cell transplantation (HCT) recipients develop xerostomia.•Mouth dryness, or xerostomia, is the main oral complaint in HCT recipients.•High-intensity conditioning causes more mouth dryness than reduced-intensity conditioning. 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 r