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