- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00476450
Effects of Stem Cell Transplantation on Bacteria in the Mouth
Effects of Peripheral Blood Stem Cell Transplantation on the Microbial Flora of the Oral Cavity
This study will examine bacteria in patients mouths at different times during stem cell transplantation and recovery. Drugs patients receive as part of the conditioning process for a stem cell transplant increase their risk of infection. There might be a link between the bacteria in the mouth and the bacteria that can cause infections. Knowing the changes in bacteria might help researchers determine the best method to prevent infections.
Patients 18 years of age and older who are scheduled to receive a stem cell transplant may be eligible for this study.
Participants undergo the following procedures:
Review of medical records
Interview about their oral care
Oral examination
Collection of oral specimens just before the stem cell transplant, immediately after the transplant, and 3 weeks after the transplant. The specimens are obtained as follows:
- <TAB>-About one-fourth teaspoon of saliva is collected with a suction device similar to that used in a dental office.
- <TAB>-Plaque from the surface of a tooth is collected with a plastic toothpick.
- <TAB>-Skin cells from the inside of the cheek and the surface of the tongue are collected with a small soft brush.
- <TAB>-If a tube is inserted into the patient s lungs to assist breathing and the patient is admitted to the intensive care unit, a specimen from the lungs is collected.
Patients are followed for 100 days after their transplant. Additional oral specimens are obtained from those who develop signs and symptoms of respiratory infection.
Study Overview
Status
Detailed Description
The mouth is a complex biological ecosystem normally containing over 700 different species of bacteria. These bacteria live in an exopolysacchride matrix biofilm. Usually, bacteria colonize the oral cavity benignly. However, there are several studies in critically ill patients demonstrating changes in oral flora with acute illness. Identification of respiratory pathogens in the mouth has led researchers to hypothesize that a relationship exists between the oral cavity and pulmonary infections. A common complication of allogeneic peripheral blood stem cell transplant (PBSCT) is infection and pneumonia. Identification of potential pathogens in the oral cavity of allogeneic stem cell patients could indicate a similar association between oral pathogens and infection. A few studies describe the oral microbial community in these patients and the possibility that these organisms are a source of infection.
The primary objective of this study is to describe the changes in oral microbial flora of allogeneic SCT patients at three time points during their treatment and recovery. Observed differences in microbial organisms from baseline (prior to transplantation), through neutropenia (within 48 hours of nadir post-transplantation) and myeloid engraftment (14-21 days post transplantation) will be described.
In the course of their treatment, if patients develop respiratory signs and symptoms that require either a re-admission to an inpatient unit or intensive care unit admission, then additional oral specimens will be collected.
The secondary objective is to assess the oral microbial flora found after development of respiratory signs and symptoms in allogeneic PBSCT patients in the first 100 days post-transplant. In addition, if the patient requires intubation, tracheal aspirates and oral specimens will be collected.
The population is composed of adult patients who are planning to undergo an allogeneic PBSCT and can provide informed consent. The design is a prospective, descriptive study of the microbial flora of the oral cavity of adult allogeneic stem cell transplant patients. Saliva specimens, dental plaque and mucosal brushings will be collected at the three different times. Oral specimens will be obtained from patients who develop respiratory signs or symptoms that require an additional inpatient or intensive care unit admission. Patients will be followed and assessed for respiratory signs, symptoms, inpatient or ICU admission until day 100 post-transplant. The presence of bacteria (type and species) will be determined by molecular genetics. The identification of bacteria will be studied using various comparative molecular techniques, including DNA arrays and Real-Time Polymerase Chain Reaction (RT-PCR).
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Maryland
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Bethesda, Maryland, United States, 20892
- National Institutes of Health Clinical Center, 9000 Rockville Pike
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
- INCLUSION CRITERIA:
All adult patients admitted to the Clinical Research Center of the NIH who are 18 years of age or older who are scheduled to undergo an allogeneic PBSCT are eligible for enrollment. Collection of oral specimens in children who are allogeneic transplant recipients would increase the anxiety in these participants and may require sedation. For this reason children will be excluded from this protocol.
All adult patients who provide informed consent and who are scheduled to receive an allogeneic bone marrow transplant are eligible for enrollment.
EXCLUSION CRITERIA:
Patients who have had recent oral surgery or oral trauma will be excluded.
Patients with tracheostomies will also be excluded.
Patients with sickle cell disease or chronic granulomatous disease who are being transplanted will be excluded from the protocol.
Patients who are less than 18 years of age will be excluded.
Study Plan
How is the study designed?
Design Details
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
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Description of the oral microbiome
Time Frame: Baseline, nadir of ANC and engraftment.
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Baseline, nadir of ANC and engraftment.
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Collaborators and Investigators
Publications and helpful links
General Publications
- Socransky SS, Haffajee AD. Periodontal microbial ecology. Periodontol 2000. 2005;38:135-87. doi: 10.1111/j.1600-0757.2005.00107.x. No abstract available.
- Mager DL, Ximenez-Fyvie LA, Haffajee AD, Socransky SS. Distribution of selected bacterial species on intraoral surfaces. J Clin Periodontol. 2003 Jul;30(7):644-54. doi: 10.1034/j.1600-051x.2003.00376.x.
- Kolenbrander PE, Andersen RN, Blehert DS, Egland PG, Foster JS, Palmer RJ Jr. Communication among oral bacteria. Microbiol Mol Biol Rev. 2002 Sep;66(3):486-505, table of contents. doi: 10.1128/MMBR.66.3.486-505.2002.
Study record dates
Study Major Dates
Study Start
Study Completion
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- 070153
- 07-CC-0153
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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