Longitudinal patient-reported oral health outcomes among patients who have received allogeneic hematopoietic stem cell transplantation

Objective

To describe longitudinal patient-reported oral health outcomes in the domains of oral health-related quality-of-life (OHRQoL) and performance status through 24 months postallogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods

This is an interim analysis using data from an ongoing National Institutes of Health natural history study (NCT03602599) of patients 18 years or older who have undergone allo-HSCT. Data were captured using the Oral Health Impact Profile-14 (OHIP-14) and standard performance status questionnaires. Means and standard deviations were calculated for continuous variables and frequencies and percentages for categorical variables. Lower OHIP-14 scores indicated better OHRQoL. All analyses were conducted using SAS 9.4.

Results

In total, 117 participants were screened for inclusion, 8 were not transplanted, and 2 withdrew consent, yielding a final study population of 107 participants at baseline, 95 at 3 months, 79 at 6 months, 72 at 12 months, 59 at 18 months, and 55 at 24 months after allo-HSCT. A total of 50.5% received a transplant for cancer, 49.5% for other reasons. 13% developed chronic graft-versus-host (cGVHD) during the study period. At time of transplant, the mean OHIP score was 3.7 (± 5.7), less than 10% of patients reported moderate-to-severe pain or dryness within the last month, 9% reported reduced oral health status compared with the previous month, and nearly all were on a full diet. Moderate-to-severe dry mouth was worst after 3 months (19% of patients), moderate-to-severe pain and dietary changes at 6 months (14% and nearly 20% of patients respectively), mean OHIP scores were worst at 12 months (4.8 ± 7.3). By 24 months, the mean OHIP was 4.1 (± 7.1), moderate-to-severe pain was reported by 9% of patients, moderate-to-severe dry mouth by 7% of patients, and nearly all were at a full diet. In cGVHD, mean OHIP was 16.8 (± 12.2), 50% reported moderate-to-severe pain, 17% reported moderate-to-severe dry mouth, 17% reported decline in oral health status, 60% were at a full diet at 24 months.

Conclusions

Data show that OHRQoL and performance status decline after allo-HSCT, with certain issues persisting through 24 months, particularly in cGVHD. Continued consideration for long-term, specialized oral health care among this patient population is indicated. Funding: NIH Intramural Research Program