Pretherapeutic plasma pro- and anti- inflammatory mediators are related to high risk of oral mucositis in pediatric patients with acute leukemia: a prospective cohort study

PLoS One. 2013 May 31;8(5):e64918. doi: 10.1371/journal.pone.0064918. Print 2013.

Abstract

Objective: This prospective study evaluated clinical risk indicators as well as pro- and anti- inflammatory mediators at the time of malignancy diagnosis in relation to chemotherapy-related oral mucositis in pediatric population.

Methods: Patients (n = 104) under 18 years of age with primary malignancies and undergoing chemotherapy were included. Potential risk indicators were analyzed using binary logistic regression with oral mucositis as the outcome. In a subgroup (n = 35), plasma samples at the time of malignancy diagnosis were analyzed for inflammatory cytokines and an antimicrobial protein pro-LL-37 (hCAP18).

Results: In the multivariable model, type of malignancy diagnosis was significantly associated with oral mucositis, with highest risk of oral mucositis in patients with acute leukemia compared to those with lymphoma or solid tumors. At the time of malignancy diagnosis, plasma from patients with acute leukemia displayed higher concentrations (P<0.05) of IL-6, IL-8, IL-10, and TNF-α and lower levels of pro-LL-37 (P<0.001).

Conclusions: The results imply that pretherapeutic high levels of inflammatory cytokines and low levels of pro-LL-37 in plasma might contribute to the high incidence of oral mucositis in patients with acute leukemia. These findings may add to our understanding of the predispositions to oral mucositis in children with malignancies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cytokines / blood
  • Disease Susceptibility / immunology
  • Female
  • Humans
  • Immunologic Factors / blood
  • Infant
  • Infant, Newborn
  • Inflammation Mediators / blood*
  • Leukemia / complications*
  • Male
  • Neoplasms / complications
  • Prospective Studies
  • Risk Factors
  • Stomatitis / blood*
  • Stomatitis / etiology*

Substances

  • Cytokines
  • Immunologic Factors
  • Inflammation Mediators

Grants and funding

This study was supported by grants from the Swedish Children’s Cancer Foundation (G.C.), the Swedish Research Council (K.P.), the Åke Wiberg Foundation (K.P.), the Swedish Society for Medicine (K.P.), as well as the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet (ALF) (T.M.). Regarding the ALF foundation, the funder requires to state as “the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet”. The ALF is the initials of the Swedish translation of the above statement. The receipt of this fund is the last author Thomas Modéer in this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.