Autologous Peripheral Stem Cell Transplant

The Role of Dentistry in the Autologous Peripheral Stem Cell Transplant

The autologous stem cell transplant is a procedure done for certain hematologic malignancies such as multiple myeloma, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma and some types of leukemia. It involves high dose chemotherapy immediately followed by an infusion of the patient’s stem cells as a supportive measure.

This requires the insertion of a central venous line (usually a Hickman line) and a period of hospitalization of approximately 2-3 weeks in relative isolation for recovery during which time there will be pancytopenia. The chemotherapy places the patient at risk of infection and with the low blood counts, dental care is not safe. Therefore, the patient requires a thorough dental and radiographic examination to remove potential sources of odontogenic infection. Obvious active dental disease requires treatment and optimal oral health should be attained prior to the transplant.

Also, the patients with multiple myeloma will also be placed on intravenous bisphosphonate therapy predisposing them to osteonecrosis of the jaws. In this group of patients, it is of the utmost importance that teeth with poor long-term prognosis be removed as early as possible.

Dental treatment plans must take into consideration the presence of the central venous line and the blood count values. Prophylactic antibiotics are recommended for the central lines and in patients with neutropenia of less than 2. The platelet count may also be a mitigating factor. As patients recover, they may be treated as normal. Therefore, it is important to update their medical history keeping these parameters in mind.