Leucemia linfoblástica de células B (LLL-B): incidência de agravos bucais e índices hematológicos em pacientes pediátricos em tratamento pelo protocolo GBTLI LLA-2009

Abstract

Among all the malignant neoplasms in childhood, lymphoblastic leukemia (ALL) is the most common, with its B cell type (ALL-B) being the most frequent. Its diagnosis is based on, among other aspects, the observation of hematological indices from the peripheral blood smear test. Besides calling for the possible presence of a malignancy, help to support the treatment, which involves chemotherapy protocol. In Brazil, the most used is the one purposed by the Grupo Brasileiro de Tratamento da Leucemia na Infância (GBTLI-2009), but the treatment causes secondary complications, such nausea, emesis, baldness, fatigue, diarrhea, besides oral impairments, specially oral mucositis. Systemic toxicity can jeopardize hematopoiesis, thus, altering patients’ hematological indices, leading to immunosuppression with or without myelosuppression. This study evaluated the incidence of oral impairments and hematological indices pediatric patients diagnosed with ALL-B, in treatment at Fundação de Hematologia e Hemoterapia do Amazonas (HEMOAM), according to GBTLI LLA-2009 protocol. The patients were submitted to intraoral screenings for oral impairments, plus evaluation of their hematological indices thru prophase and induction chemotherapy. The data analysis was performed by Mann Whitney and Fisher’s exact test, with p ≤ 0,05. Within the 21 patients evaluated, 57,14% (n=12) were males, with age’s mean being 5 years-old. The majority of patients was categorized as being in the low relapse risk group (80,96%; n= 17). Regarding the oral impairments classically related to and/or seen during chemotherapy to ALL, 28,57% (n=6) of the patients presented some sort of those impairments, specially oral mucositis. On the other side, 61,90% (n=13) of the patients presented non-specific oral impairments, with the most prevalent one being dental caries, with 71,42% (n=15). Most of the patients presented leukocytosis at diagnose, which was followed by leukopenia thru prephasis and induction of chemotherapy, with similar drop in the lymphocyte, neutrophils and blsts, with no statistical differences among other hematological indices. No relation was found between oral impaiments and hematological indexes at any moment of prephasis and induction of chemotherapy by the GBTLI LLA-2009 protocol. So, the conclusions were that the incidence of oral impairments in ALL-B patients treated at HEMOAM is very low, apparently with no relationship with the hematological indexes found on those patients. On the other side, this low prevalence of oral impairments may be because of the dentist inserted in the multidisciplinary team treating the ALL patients, treating the oral impairments that show up during the chemotherapy.