Periodontal changes after haematopoietic cell transplantation and the role of conditioning regimen intensity

Abstract

Purpose: To evaluate periodontal health after allogeneic haematopoietic cell transplantation (HCT), and its association with conditioning regimen intensity.

Methods: This single-centre retrospective cohort study included 82 allogeneic HCT recipients between 01/08/2017 and 31/03/2022. Probing pocket depth (PPD), bleeding on probing (BOP), periodontal epithelial surface area (PESA) and periodontal inflamed surface area (PISA) were assessed pre- and post-HCT. Change scores were calculated, and regression models were applied to analyse associations with conditioning intensity. Conditioning regimens were categorised based on intensity as non-myeloablative (NMA), reduced intensity (RIC) or myeloablative (MA).

Results: HCT recipients had a median age of 59 years (IQR 48-66); 63% were male. Median time to HCT was 53 days (IQR 29-89), median follow-up was 279 days (IQR 183-349). Severe periodontitis (≥ 1 site with PPD ≥ 6 mm) was observed in 37% of patients pre-HCT and 20% of patients post-HCT. PPD, BOP, PESA and PISA decreased from pre- to post-HCT, by 0.26 mm [95%CI 0.16;0.37], 8% [95%CI 5;12], 140 mm² [95%CI 89;190] and 123 mm² [95%CI 83;185], respectively. Prevalence of severe periodontitis decreased from pre- to post-HCT in all groups: NMA 50% to 27%, RIC 32% to 19%, MA 31% to 13%. Conditioning intensity was statistically significantly associated with post-HCT PPD and PESA; however, differences were small. No statistically significant differences were observed in post-HCT PISA between conditioning regimens.

Conclusion: Periodontal health improved marginally in the short-term following HCT and supportive oral care. Differences in post-HCT periodontal health between patients conditioned with NMA, RIC, and MA were not clinically relevant.

Keywords: Conditioning regimen intensity; Dentition; Longitudinal clinical study; Periodontal disease; Periodontium; Stem cell transplantation.

Fig. 1

Flowchart of the study population. Reasons for exclusion are shown at the right side of the chart

Fig. 2

Prevalence of patients with periodontal pocket(s) equal or more than 6 mm according to the amount of pocket sites at three timepoints (pre-HCT, following pre-HCT extractions, post-HCT). Abbreviations: HCT = haematopoietic cell transplantation; PPD = probing pocket depth

Fig. 3

Pre-HCT PPD after extractions, post-HCT PPD and change in PPD (mm) per conditioning intensity. Negative change score implies a reduction in PPD from pre- to post-HCT. Abbreviations: PPD = probing pocket depth; NMA = non-myeloablative conditioning; RIC = reduced intensity conditioning; MA = myeloablative conditioning; HCT = haematopoietic cell transplantation

Fig. 4

Pre-HCT PESA and PISA after extractions, post-HCT PESA and PISA and change in PESA and PISA (mm2) per conditioning intensity. Negative change score implies a reduction from pre- to post-HCT. The boxes represent the interquartile range, and the upper and lower whiskers extend to the maximum and minimum values excluding outliers. Abbreviations: PESA = periodontal epithelial surface area; PISA = periodontal inflamed surface area; NMA = non-myeloablative conditioning; RIC = reduced intensity conditioning; MA = myeloablative conditioning; HCT = haematopoietic cell transplantation

Fig. 5

Impact of different conditioning regimen intensities on post-HCT PPD (mm), PESA (mm²) and PISA (mm²) (corrected for pre-HCT values). MA conditioning serves as the reference category. Whiskers represent 95% confidence intervals. Analyses are adjusted for age, sex, smoking behaviour, comorbidity index, follow-up time, and additionally for number of teeth for PESA and PISA outcomes. Abbreviations: MA = myeloablative conditioning; RIC = reduced intensity conditioning; NMA = non-myeloablative conditioning; PPD = probing pocket depth; PESA = periodontal epithelial surface area; PISA = periodontal inflamed surface area; HCT = haematopoietic cell transplantation; CI = confidence interval