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

Objective: To assess changes in the salivary expression of IL-1 alpha, IL-1 beta, 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. Methods: 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 degrees 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. Results: Forty-one patients were followed up, and 17 (41.5%) developed OLs. OL patients had higher baseline salivary IL-1 alpha than those without lesions (p = 0.040). During visit 2, OL patients had higher levels of IL-1 alpha (p = 0.033), IL-1 alpha (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). Conclusion: AL patients undergoing chemotherapy with high salivary TNF levels were more likely to develop HSV infection, OC, and OM.