Haematopoietic stem cell transplantation and oral complications

De ontwikkeling van nieuwe procedures heeft ertoe geleid dat een hematopoëtische stamceltransplantatie tegenwoordig ook kan worden toegepast bij patiënten die vroeger niet hiervoor in aanmerking kwamen, zoals ouderen. Tevens leiden deze ontwikkelingen tot verschuivingen in het spectrum van complicaties als gevolg van hematopoëtische stamceltransplantatie. In dit artikel komen de belangrijkste principes van hematopoëtische stamceltransplantatie aan de orde en de verschillende orale complicaties die hierbij kunnen optreden: mucositis, infecties, bloedingen, graft-versus-hostziekte, xerostomie, hyposialie, smaakverandering, secundaire tumoren, osteoporose, osteonecrose en groei- en ontwikkelingsstoornissen. Tot slot wordt aandacht besteed aan de rol van mondzorgverleners bij een hematopoëtische stamceltransplantatie.New haematopoietic stem cell transplantation procedures make the treatment available to patients who previously did not qualify, such as the elderly. In addition, the spectrum of oral complications associated with haematopoietic stem cell transplantation has altered as a result of the recent developments. This article is a review of the main principles of haematopoietic stem cell transplantation and provides information on oral complications which may develop, such as mucositis, infections, bleeding, graft-versus-host disease, xerostomia, hyposalivation, altered taste, secondary tumors, osteoporosis, osteonecrosis and growing and developing disturbancies. Finally, the role of dental care providers in cases of haematopoietic stem cell transplantation is addressed.</p

Haematopoietic stem cell transplantation and oral complications

De ontwikkeling van nieuwe procedures heeft ertoe geleid dat een hematopoëtische stamceltransplantatie tegenwoordig ook kan worden toegepast bij patiënten die vroeger niet hiervoor in aanmerking kwamen, zoals ouderen. Tevens leiden deze ontwikkelingen tot verschuivingen in het spectrum van complicaties als gevolg van hematopoëtische stamceltransplantatie. In dit artikel komen de belangrijkste principes van hematopoëtische stamceltransplantatie aan de orde en de verschillende orale complicaties die hierbij kunnen optreden: mucositis, infecties, bloedingen, graft-versus-hostziekte, xerostomie, hyposialie, smaakverandering, secundaire tumoren, osteoporose, osteonecrose en groei- en ontwikkelingsstoornissen. Tot slot wordt aandacht besteed aan de rol van mondzorgverleners bij een hematopoëtische stamceltransplantatie.New haematopoietic stem cell transplantation procedures make the treatment available to patients who previously did not qualify, such as the elderly. In addition, the spectrum of oral complications associated with haematopoietic stem cell transplantation has altered as a result of the recent developments. This article is a review of the main principles of haematopoietic stem cell transplantation and provides information on oral complications which may develop, such as mucositis, infections, bleeding, graft-versus-host disease, xerostomia, hyposalivation, altered taste, secondary tumors, osteoporosis, osteonecrosis and growing and developing disturbancies. Finally, the role of dental care providers in cases of haematopoietic stem cell transplantation is addressed.</p

Haploidentical transplantation in patients with multiple myeloma making use of natural killer cell alloreactive donors

Disease relapse is an important problem after allogeneic stem cell transplantations in multiple myeloma (MM). To test the hypothesis that natural killer (NK) cell alloreactivity in the setting of a haploidentical stem cell transplantation (haploSCT) can reduce the risk of myeloma relapse, we performed a small prospective phase 2 study in which we transplanted poor-risk MM patients using a killer cell immunoglobulin-like receptor (KIR)-ligand mismatched haploidentical donor. Patients received bone marrow grafts after reduced-intensity conditioning, with post-transplantation cyclophosphamide (PTCY) graft-versus-host-disease (GVHD) prophylaxis. The primary endpoint was 1.5-year progression-free survival (PFS); stopping rules were installed in case interim results made a benefit of 50% PFS at 1.5 years unlikely. After inclusion of 12 patients, of which 9 were evaluable for the primary endpoint, all patients relapsed within a median time of 90 days. All except 1 patient showed engraftment, with a median time to neutrophil recovery of 18 (12-30) days. The study was prematurely terminated based on the predefined stopping rules after the inclusion of 12 patients. With this small study, we show that in chemo-resistant myeloma patients, NK cell KIR-mismatch is not superior to conventional alloSCT. This strategy, however, can serve as a platform for new treatment concepts. Clinical Trial Registry: NCT02519114Immunobiology of allogeneic stem cell transplantation and immunotherapy of hematological disease