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Oral Dis. 2017 Oct;23(7):941-948. doi: 10.1111/odi.12677. Epub 2017 May 16.

TNF as marker of oral candidiasis, HSV infection, and mucositis onset during chemotherapy in leukemia patients.

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Master's Course in Oral Pathology and Oral Medicine, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, México.
Biochemical Unit, Department of Genomic Medicine and Environmental Toxicology, Biomedical Research Institute, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Universidad Nacional Autónoma de México, Mexico City, México.
Liason Unit of the Faculty of Medicine, Instituto Nacional de Medicina Genómica, Universidad Nacional Autónoma de México, Mexico City, México.
Clinical Epidemiology Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.



To assess changes in the salivary expression of IL-1α, IL-1β, IL-2, IL-6, IL-10, IL-17, and TNF in acute leukemia (AL) patients before and during chemotherapy, and its association with HSV infection, oral candidiasis (OC), and oral mucositis (OM) onset.


Cohort study in AL patients >15 years starting induction chemotherapy at a Mexican oncological center (2013-2014). Onset of oral lesions (OLs) was assessed during follow-up, and saliva was obtained at baseline, at visit 2 (days 4-12), and at visit 3 (days 13-21) after chemotherapy, treated with a protease inhibitor and stored at -70°C. An enzyme-linked immunosorbent assay was performed. Cox proportional hazards regression models were constructed to estimate hazard ratios and its 95% CI (HR, 95% CI) for OL development.


Forty-one patients were followed up, and 17 (41.5%) developed OLs. OL patients had higher baseline salivary IL-1α than those without lesions (p = 0.040). During visit 2, OL patients had higher levels of IL-1α (p = 0.033), IL-1β (p = 0.016), IL-6 (p = 0.035), and TNF (p = 0.019) than those who did not develop OLs. Patients with HSV infection, OC, and OM showed higher salivary TNF levels during follow-up (HR: 3.52, 95% CI: 1.35-9.14, p = 0.010).


AL patients undergoing chemotherapy with high salivary TNF levels were more likely to develop HSV infection, OC, and OM.


acute leukemia; chemotherapy; inflammatory cytokines; oral lesions; oral mucositis; saliva

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