The incidence of severe oral mucositis in patients undergoing different conditioning regimens in haematopoietic stem cell transplantation

Midori Nakagaki, Glen A Kennedy, Nicole C Gavin, Alexandra Clavarino, Karen Whitfield, Midori Nakagaki, Glen A Kennedy, Nicole C Gavin, Alexandra Clavarino, Karen Whitfield

Abstract

Purpose: Oral mucositis is a common complication during haematopoietic stem cell transplantation (HSCT). This study aimed to assess the incidence of severe mucositis in patients undergoing different HSCT regimens.

Methods: This single-centre retrospective study reviewed daily oral assessment for 467 consecutive patients who underwent different transplant regimens for matched unrelated or related allogeneic HSCT with post-transplant methotrexate, haploidentical or mismatched HSCT with post-transplant cyclophosphamide (PTCy), or autologous HSCT. Oral care and cryotherapy with melphalan were used. Patient demographic data, oral mucositis WHO grade, use of total parenteral nutrition (TPN) and patient-controlled analgesia (PCA) were collected.

Results: Grade 3-4 oral mucositis was common in myeloablative total body irradiation (TBI)-based regimens cyclophosphamide/ TBI (CyTBI) (71%) and fludarabine/ TBI (FluTBI) with PTCy (46%), as well as reduced-intensity fludarabine/melphalan (FluMel) (43%) and carmustine/etoposide/cytarabine/melphalan (BEAM) autologous HSCT (41%). In contrast, grade 3-4 oral mucositis was less common in reduced-intensity haploidentical regimen melphalan/fludarabine/TBI with PTCy (19%), all non-myeloablative regimens (0-9%) and high-dose melphalan autologous HSCT (26%). TPN and PCA use were correlated to oral mucositis severity.

Conclusions: Severe oral mucositis was associated with myeloablative TBI, methotrexate and melphalan in combination with methotrexate and in BEAM. Use of PTCy was preferable over methotrexate to prevent oral mucositis.

Keywords: Conditioning; Haematopoietic stem cell transplantation; Oral mucositis; Risk factors.

Conflict of interest statement

This study was conducted as a part of principal author’s Doctor of Philosophy degree. She has received a scholarship from the Royal Brisbane and Women’s Hospital Foundation. Other authors declare no competing financial interests.

© 2022. Crown.

Figures

Fig. 1
Fig. 1
Daily oral assessment sheet routinely used in the HSCT unit
Fig. 2
Fig. 2
Incidence of grade 3–4 and grade 2–4 oral mucositis. Refer Table 1 for details of conditioning regimens
Fig. 3
Fig. 3
Mean duration (days) of grade 3 to 4 and grade 2 to 4 oral mucositis. Refer Table 1 for details of conditioning regimens
Fig. 4
Fig. 4
Use of TPN and PCA. TPN, total parenteral nutrition; PCA, patient-controlled analgesia. Refer Table 1 for details of conditioning regimens
Fig. 5
Fig. 5
Incidence of oral mucositis and TPN/PCA use in gender received FluMel (N = 197, female = 70, male = 127). The incidence of grade 3 to 4 OM (p = 0.05), TPN use (p = 0.02) and PCA use (p = 0.02) were significantly higher in female. The incidence of grade 2 to 4 OM (p = 0.34) was nonsignificantly higher in female patients. TPN, total parenteral nutrition; PCA, patient-controlled analgesia; FluMel, fludarabine/melphalan; OM, oral mucositis

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Source: PubMed

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