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164 rev port estomatol med dent cir maxilofac. 2019;60(4):163-168

Avaliação da mucosa bucal de pacientes com leucemia linfocítica aguda:
Estudo de série de casos

r e s u m o

Palavras-chave: Objetivo: Avaliar prospectivamente a mucosa bucal de pacientes pediátricos com Leucemia
Leucemia linfocítica aguda Linfoblástica Aguda (LLA) quanto ao seu aspecto clínico e expressão de membros da família
Herpesviridae HHV.
Mucosite oral Métodos: No período de setembro de 2014 a janeiro de 2015, foram avaliados consecutiva-
Reação em cadeia da polimerase mente, uma série de nove pacientes com idades entre 2 e 14 anos atendidos na Fundação
de Hematologia e Hemoterapia do Amazonas (HEMOAM). A mucosa bucal desses pacientes
foi avaliada clinicamente quanto a alterações bucais e por meio de PCR para detecção do
DNA do HSV-1, CMV e EBV em 4 momentos da pré-fase/indução (P/I), sendo eles D0/D1, D8,
D15 e D35, assim como em 4 momentos da consolidação da remissão (CR), sendo eles D1,
D15, D29 e D50 pelo protocolo do Grupo Brasileiro de Leucemias na infância (GBTLI LLA 2009).
Resultados: Foi observada maior prevalência de crianças com 2 anos de idade (66,7%, n=6),
do sexo masculino (66,7%, n=6) e com diagnóstico de LLA de células B (88,9%, n=8). Alterações
bucais foram observadas somente em 33,3% (n=3) dos pacientes, sendo elas eritema (D35
P/I), lábios ressecados (D8 e D15 P/I) e relato de xerostomia (D15 P/I). Nenhuma das amostras
foi positiva para HSV-1 e CMV, no entanto 33,3% (n= 3) dos casos apresentaram expressão
do EBV (D8 e D15 P/I).
Conclusões: Alterações bucais e presença dos vírus HSV-1, CMV e EBV nos pacientes com LLA
avaliados mostrou-se inexpressiva, estando a maioria dos pacientes com mucosa hígida ao
longo do tratamento. Não se pode afirmar que os vírus analisados integrem a microbiota
desses pacientes, no entanto, há indícios de que a presença do EBV seja mais esperada que
o HSV-1 e CMV. (Rev Port Estomatol Med Dent Cir Maxilofac. 2019;60(4):163-168)
© 2019 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

MOAM). The HEMOAM is the only public reference service for
Introduction
treatment of childhood leukemia in the Northern region, with
15
Acute lymphocytic leukemia (ALL) is the most common ma- an annual demand of approximately 40 new ALL cases. Due
lignant neoplasm in childhood and adolescence with a preva- to the lack of publications related to the profile of ALL patients
5
lence peak at 2 to 5 years of age. 1-3 It is frequently sensible to in treatment with GBTLI ALL-2009, this study aims to evaluate
chemotherapy, having an event-free survival rate of 90% the buccal mucosa of such patients regarding its clinical aspect
when the ideal therapeutic regimen, based on subgroup strat- and expression of the Herpesviridae (HHV) family members in
4
ification, is adopted. This regimen’s treatment strategies several moments of the adopted chemotherapy protocol.
comprehend phases, such as the induction, consolidation
and maintenance phases. 5
Secondary complications, such as mucocutaneous pallor, fe- Material and methods
ver, asthenia, lymphadenopathy, xerostomia, cushingoid facies,
hemorrhage, mucositis, candidiasis, ulcers and alterations on the This research represents a case series study composed of
saliva constituents with swallowing impairment may arise as a nine consecutive cases of children and adolescents diagnosed
consequence of the chemotherapy treatment. 6-9 The presence of with ALL, of both genders, with ages ranging from 2 to 14
microorganisms is an aggravating factor of those effects. 10 years, from September 2014 to January 2015 in the HEMOAM
The type-1 herpes simplex virus (HSV-1) has an important Foundation. The procedures of this study follow the guide-
role on the severity of chemotherapy-induced buccal mucosi- lines established by the ethics committee of the Federal Uni-
tis in patients with hematological neoplasms, 10-12 as do the versity of Amazonas (UFAM protocol: 30934514.9.0000.5020)
Epstein-Barr virus (EBV) and the cytomegalovirus (CMV), rep- and HEMOAM (Protocol: 30934514.9.3001.0009).
resenting a threat to immunocompromised patients. 13,14 A clinical analysis was performed to search for possible
In the ’80s, the first multicenter protocol for the treatment alterations of the lips, cheek mucosa, tongue, floor of the
of childhood ALL (GBTLI-80) was created in Brazil and it is cur- mouth, hard and soft palate, oropharynx, gums and surround-
rently in its sixth version (GBTLI-2009). This protocol has been ing regions, using a mouth mirror, a wooden spatula, gauze
used in about 14 treatment centers in Brazil, one of which is and proper biosecurity equipment. When buccal mucositis
the Amazon Hematology and Hemotherapy Foundation (HE- was observed, it was graded according to the Oral Toxicity