Risk factors and implications of oral mucositis in recipients of allogeneic hematopoietic stem cell transplantation. (12th August 2019)

• Record Type: Journal Article
• Authors: Shouval, Roni; Kouniavski, Elizaveta; Fein, Joshua; Danylesko, Ivetta; Shem‐Tov, Noga; Geva, Mika; Yerushalmi, Ronit; Shimoni, Avichai; Nagler, Arnon
• Is Part Of: European journal of haematology. Volume 103:Number 4(2019)
• Page Start: 402
• Page End: 409
• Publication Date: 2019-08-12
• Subjects: allogeneic hematopoietic stem cell transplantation -- conditioning -- oral mucositis -- risk factors -- treosulfan; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; Blood -- Periodicals; 616.15005
• DOI: 10.1111/ejh.13299
• Languages: English
• ISSNs: 0902-4441

Abstract

Abstract: Background: Oral mucositis (OM) is a common toxicity of stem cell transplantation (SCT). We sought to evaluate OM burden, risk factors, and implications in a cohort of allogeneic‐SCT recipients. Methods: This was a single‐center study including 115 adult allogeneic‐SCT transplanted between 2016 and 2018 for various hematological conditions. Conditioning intensity was categorized as myeloablative (MAC, 39%), reduced intensity (34%), or reduced toxicity (RTC, 27%) in patients conditioned with fludarabine‐treosulfan. OM was prospectively graded using the Common Terminology Criteria for Adverse Events (v.4.0) system. Results: Moderate‐to‐severe OM (grade 2‐4) was experienced by 60% of patients. In a univariate analysis, younger age ( P = .023), lower body mass index ( P = .01), recent smoking ( P = .08), recent antibiotics exposure ( P = .018), MAC ( P < .001), and methotrexate ( P = .009) were associated with moderate‐to‐severe OM. In a multivariable logistic regression model, conditioning and graft‐versus‐host disease prophylaxis remained significant. OM risk was lowest with RTC (RTC vs MAC: odd ratio [OR] 0.05, P < .001), and recent antibiotic exposure trended toward increased risk (OR 1.88, P = .168). OM was associated with longer hospitalization, delayed neutrophil engraftment, and gastrointestinal‐related infections. Conclusion: Oral mucositis remains a leading SCT complication. Treosulfan‐based conditioning has low mucosal toxicity and is appealing given previous reports on its high efficacy.