Is Edentulism Associated with Lower Bacteremia and Transplant-Associated Toxicities in Patients with Multiple Myeloma?

Objective: Previous studies suggest that edentulous (subjects without teeth) have a lower inflammatory state than non-edentulous individuals probably due to periodontal infection in non-edetulous subjects. We hypothesized that edentulous patients would have a lower incidence of bacteremia and other complications associated with autotransplantation for multiple myeloma (MM).

Methods: We conducted a retrospective case-control study of patients who received autologous hematopoietic stem cell transplantation (AHSCT) for multiple MM at the Audie L. Murphy Memorial Veterans Hospital Bone Marrow Transplant Unit, in San Antonio, Texas from January 2003 through September 2012. Case subjects were defined as edentulous and controls were defined as non-edentulous. The 2 groups were matched for age, gender, ethnicity, MM stage, time from diagnosis to transplant, performance status, and conditioning regimen. The following posttransplant toxicities were analyzed: bacteremia, oral mucositis, nausea/vomiting, diarrhea, neutrophil engraftment and length of hospital stay.

Results: During the study period, 297 AHSCT were performed at our institution. Of these, 45 (15%) patients were found to be edentulous at the time of first AHSCT. Forty-five case subjects were matched to 90 controls. All patients were males, their median age was 60 years (range, 42-75), their Karnofsky performance status score mean was 90 (range, 70-90), and all received melphalan as part of the conditioning regimen. The majority of patients, 90 (67%) had stage III MM at transplantation and the median time from diagnosis to transplantation was 12 months (range, 4-103).

The incidence and severity of all posttransplant toxicities analyzed were similar in both groups (see table). Thirty-eight (84%) of edentulous patients were smokers or had a history of smoking at the time of AHSCT compared to 58 (64%) of the control group (p = 0.016). Overall survival after transplant was similar in both groups.

Conclusions: The incidence of toxicities after AHSCT experienced by edentulous MM patients was similar to controls including bacteremia and oral mucositis. There was a strong association between edentulism and smoking.

Table. Post-AHSCT patient toxicities

	Edentulous N=45	Control Group N=90	p-value
Bacteremia, n (%)      Yes      No	11 (24) 34 (76)	18 (20) 72 (80)	0.553
Oral mucositis, n (%)      Grade 0      Grade 1      Grade 2      Grade 3	13 (29) 16 (36) 13 (29) 3 (7)	33 (37) 21 (23) 27 (30) 9 (10)	0.465
Nausea/Vomiting, n (%)      Grade 0      Grade 1      Grade 2      Grade 3	4 (9) 24 (53) 14 (31) 3 (7)	7 (8) 40 (44) 36 (40) 7 (8)	0.744
Diarrhea, n (%)      Grade 0      Grade 1      Grade 2      Grade 3      Grade 4	6 (13) 7 (16) 15 (33) 14 (31) 3 (7)	10 (11) 17 (19) 24 (27) 39 (43) 0 (0)	0.095
Days to ANC engraftment      Mean (SD)      Range	10.84 (1.80) 8-31	10.83 (1.16) 9-17	0.966
Length of hospital stay (days)      Mean (SD)      Range	15.76 (4.94) 3-30	17.47 (5.99) 3-52	0.098