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Risk factors and implications of oral mucositis in recipients of allogeneic hematopoietic stem cell transplantation
Author(s) -
Shouval Roni,
Kouniavski Elizaveta,
Fein Joshua,
Danylesko Ivetta,
ShemTov Noga,
Geva Mika,
Yerushalmi Ronit,
Shimoni Avichai,
Nagler Ar
Publication year - 2019
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13299
Subject(s) - mucositis , medicine , treosulfan , common terminology criteria for adverse events , transplantation , hematopoietic stem cell transplantation , univariate analysis , graft versus host disease , surgery , gastroenterology , fludarabine , adverse effect , toxicity , busulfan , chemotherapy , multivariate analysis , cyclophosphamide
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.