Quantificação do HSV-1 na mucosa bucal de pacientes pediátricos com Leucemia Linfoblástica Aguda

Abstract

Acute Lymphoblastic Leukemia (ALL) is the most common malignancy in children, especially in males and chemotherapy is generally the treatment for these patients. Minor side effects of therapy have been reported, and mucositis is one of the most common. It has been suggested in the literature that HSV-1 plays an important role in the severity of oral mucositis in patients with onco-hematological diseases. This study quantified HSV-1 in the oral mucosa of pediatric ALL patients undergoing GBTLI ALL-2009 protocol, from the Foundation of Hematology of the Amazon (HEMOAM), correlating viral load to the different stages of treatment and also to the presence and grading of oral mucositis. We evaluated twenty patients by clinical examination of the oral mucosa to identify oral lesions and also collected cells from buccal mucosa in several times and phases of chemotherapy. These samples were submitted to DNA extraction followed by detection and quantification of HSV-1 using Real Time PCR. Data were analyzed using Mann-Whitney and Kruskal Wallis test with a significance level of p ≤ 0.05. Of all patients, half of them were male, between 1 and 6 years (80%) and with ALL Type B low risk (75%). Dry mouth (15%) and oral mucositis (35%) were the oral lesions found. It was detected HSV-1 presence in the oral mucosa of 80% of patients at some stage of chemotherapy with predominance of the virus in the intensification phase only in patients with ALL B high risk, with no differences in viral load of HSV -1 at different stages of treatment in LLA B group of low risk. Higher incidence of mucositis was observed in prefase/induction (75%) with higher levels of the virus in these patients compared to those free of mucositis, but without statistical significance. It is suggested that HSV-1 is frequent in the buccal mucosa of patients with B ALL, and its viral load may be different in subtypes of ALL B. However, the role of HSV-1 at the onset of oral mucositis not it is certain.