Periodontal changes after haematopoietic cell transplantation and the role of conditioning regimen intensity

TL;DR

This study examines how periodontal health changes after hematopoietic cell transplantation and whether the intensity of the conditioning regimen affects these changes.

Contribution

The study provides new insights into the relationship between conditioning regimen intensity and periodontal outcomes following allogeneic HCT.

Findings

Periodontal health improved marginally in the short-term following HCT and supportive oral care.

Differences in post-HCT periodontal health between patients conditioned with NMA, RIC, and MA were not clinically relevant.

Abstract

To evaluate periodontal health after allogeneic haematopoietic cell transplantation (HCT), and its association with conditioning regimen intensity.

This single-centre retrospective cohort study included 82 allogeneic HCT recipients between 01/08/2017 and 31/03/2022. Probing pocket depth (PPD), bleeding on probing (BOP), periodontal epithelial surface area (PESA) and periodontal inflamed surface area (PISA) were assessed pre- and post-HCT. Change scores were calculated, and regression models were applied to analyse associations with conditioning intensity. Conditioning regimens were categorised based on intensity as non-myeloablative (NMA), reduced intensity (RIC) or myeloablative (MA).

HCT recipients had a median age of 59 years (IQR 48–66); 63% were male. Median time to HCT was 53 days (IQR 29–89), median follow-up was 279 days (IQR 183–349). Severe periodontitis (≥ 1 site with PPD ≥ 6 mm) was observed in 37% of patients pre-HCT and 20% of patients post-HCT. PPD, BOP, PESA and PISA decreased from pre- to post-HCT, by 0.26 mm [95%CI 0.16;0.37], 8% [95%CI 5;12], 140 mm2 [95%CI 89;190] and 123 mm2 [95%CI 83;185], respectively. Prevalence of severe periodontitis decreased from pre- to post-HCT in all groups: NMA 50% to 27%, RIC 32% to 19%, MA 31% to 13%. Conditioning intensity was statistically significantly associated with post-HCT PPD and PESA; however, differences were small. No statistically significant differences were observed in post-HCT PISA between conditioning regimens.

Periodontal health improved marginally in the short-term following HCT and supportive oral care. Differences in post-HCT periodontal health between patients conditioned with NMA, RIC, and MA were not clinically relevant.

The online version contains supplementary material available at 10.1007/s00520-025-09654-9.

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