Oral Manifestations of Leukemia

The oral manifestation of leukemia can be summarized as follows.

In acute leukemias localized or generalized gingival hyperplasia is generally observed.

It mainly affects the interdental papillae and the marginal gingiva.

It is caused by inflammation, or leukemic infiltration, and may be localized or generalized, the latter being the most common form.

The infiltration of leukemic cells may also involve periapical tissues and simulate, both clinically and radiographically, periapical inflammatory lesions.

In chronic leukemia, the leukemic infiltrates in oral tissues is less frequent and can be observed:

  1. Pallor of the mucosa
  2. Soft tissue infections
  3. Generalized lymphadenopathy

The manifestations of thrombocytopenia are more common when the platelet count is below 50,000 cells/mm3 and may manifest as bruising, petechiae in the hard and soft palate, and also spontaneous gingival bleeding, especially if the platelet count is below 20,000 cells/mm3.

Opportunistic infections with Candida albicans and Herpes viruses are common and can involve any area of the mucosa. Ulcers can also result from impaired immune defense in combating normal microbial flora.

Oral Manifestations Related to Hematopoietic stem cell transplantation (HSCT)

The most common oral manifestations related to pre-, immediate post-, and late post-HSCT are summarized in Table 1.

The oral manifestations that may be present are correlated with the phases of HSCT:

  1. Preconditioning: oral infections, ulceration, bleeding, and temporomandibular joint dysfunction;
  2. Neutropenic phase conditioning: mucositis, dysgeusia, xerostomia, bleeding, oral pain, opportunistic infections, neurotoxicity, and temporomandibular dysfunction, usually manifesting with high prevalence and severe forms; at this stage, the patient may develop hyperacute GVHD with further severe oral complications;
  3. Engraftment to hematopoietic recovery: opportunistic infections are common and acute GVHD becomes a concern; bleeding may be present, xerostomia, neurotoxicity, granulomas/papillomas, and temporomandibular dysfunction;
  4. Immune reconstitution/recovery from systemic toxicity: salivary dysfunction, late viral infections, craniofacial growth abnormalities, cGVHD, and squamous cell carcinoma; and
  5. The long-term survival: in pediatric patients, particularly children under 6 years, one can observe complications in the development of bones and teeth; at this stage, recurrence and malignant neoplasms can be observed.
  6. In the occurrence of GVHD, mucositis, gingivitis, erythema, and pain are usually observed.

In cGVHD, the most common oral manifestations are lichen-type features, hyperkeratotic plaques, mucocele, atrophic mucosa, ulceration, fibrosis with limited mouth opening, hyposalivation, and xerostomia,In addition, secondary to cGVHD, the patients have a greater tendency to develop malignancies.

 

Leukemia and its treatment

Special considerations regarding oral complications, oral health, and dental treatment in Hemopoetic Stem Cell Transplantation

 

 

 

Reference: Caroline Zimmermann, Maria Inês Meurer, Liliane Janete Grando, Joanita Ângela Gonzaga Del Moral, Inês Beatriz da Silva Rath, and Silvia Schaefer Tavares Journal of Oncology Volume 2015 (2015), Article ID 571739, 14 pages http://dx.doi.org/10.1155/2015/571739