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. 2023 Jul 8;31(8):449.
doi: 10.1007/s00520-023-07921-1.

The effect of hematopoietic stem cell transplantation on patient-reported subjective oral dryness: a systematic review focusing on prevalence, severity and distress

Marjolein S Bulthuis  1 , Lucky L A van Gennip  2 , Ewald M Bronkhorst  2 , Nicole M A Blijlevens  3 , Marie-Charlotte D N J M Huysmans  2 , Stephanie J M van Leeuwen  2 , Renske Z Thomas  2
Affiliations

The effect of hematopoietic stem cell transplantation on patient-reported subjective oral dryness: a systematic review focusing on prevalence, severity and distress

Marjolein S Bulthuis et al. Support Care Cancer. .

Abstract

Objective: The aim of the present systematic review is to assess the prevalence and severity of and distress caused by xerostomia over time in adult hematopoietic stem cell transplantation (HSCT) recipients.

Methods: PubMed, Embase, and the Cochrane Library were searched for papers published between January 2000 and May 2022. Clinical studies were included if patient-reported subjective oral dryness was reported in adult autologous or allogeneic HSCT recipients. Risk of bias was assessed according to a quality grading strategy published by the oral care study group of the MASCC/ISOO, resulting in a score between 0 (highest risk of bias) and 10 (lowest risk of bias). Separate analysis focused on autologous HSCT recipients, allogeneic HSCT recipients receiving a myeloablative conditioning (MAC), and those receiving a reduced intensity conditioning (RIC).

Results: Searches yielded 1792 unique records; 22 studies met the inclusion criteria. The quality scores ranged between 1 and 7, with a median score of 4. The prevalence, severity, and distress of xerostomia increased shortly after HSCT. Severity of xerostomia in allogeneic MAC recipients was higher compared to allogeneic RIC recipients 2-5 months post-HSCT (mean difference: 18 points on 0-100 scale, 95% CI: 9-27); after 1-2 years, there was no significant difference anymore.

Conclusion: The prevalence of xerostomia in HSCT recipients is high in comparison to the general population. The severity of complaints is raised during the first year post-HSCT. The intensity of the conditioning plays a key role in the short-term development of xerostomia, while factors affecting the recovery in the long term remain largely unknown.

Keywords: Hematopoietic stem cell transplantation; Patient-reported oral dryness; Subjective mouth dryness; Systematic review; Xerostomia.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram [29]
Fig. 2
Fig. 2
Prevalence of xerostomia over time. Prevalence of xerostomia as reported in 14 studies represented by different colors, including both autologous and allogeneic HSCT recipients. The size of the circles refers to the quality of the reported outcome (the larger the circle, the lower the risk of bias). Proportion of allogeneic HSCT recipients per time period is listed below the graph. The gray dotted line represents the prevalence of xerostomia in the general population [56]
Fig. 3
Fig. 3
Severity of xerostomia over time. Rescaled severity of xerostomia (0–100) as reported in 13 studies represented by different colors, including both autologous and allogeneic HSCT recipients. The size of the circles refers to the quality of the reported outcome (the larger the circle, the lower the risk of bias). Proportion of allogeneic HSCT recipients per time period is listed below the graph
Fig. 4
Fig. 4
Distress caused by xerostomia over time. Rescaled distress (0–100) caused by xerostomia as reported in 6 studies represented by different colors, including both autologous and allogeneic HSCT recipients. The size of the circles refers to the quality of the reported outcome (the larger the circle, the lower the risk of bias). Proportion of allogeneic HSCT recipients per time period is listed below the graph
Fig. 5
Fig. 5
a Severity of xerostomia in autologous HSCT recipients. Rescaled severity of xerostomia (0–100) in autologous HSCT recipients as reported in 5 studies, represented by different colors. The size of the circles refers to the quality of the reported outcome (the larger the circle, the lower the risk of bias). b Severity of xerostomia in allogeneic HSCT recipients. Rescaled severity of xerostomia (0–100) in allogeneic HSCT recipients as reported in 6 studies, represented by different colors. Patients receiving a myeloablative conditioning regimen (MAC) are represented by solid lines and circles; patients receiving a reduced intensity conditioning regimen (RIC) are represented by dashed lines and empty circles. The size of the circles refers to the quality of the underlying subgroup (the larger the circle, the lower the risk of bias)
See this image and copyright information in PMC

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