A prospective, randomized trial for the prevention of mucositis in patients undergoing hematopoietic stem cell transplantation

Abstract

Summary:Oral mucositis is a complication common to many cancer therapies and produces considerable pain and morbidity. The present study reports a double-blind, prospective, randomized clinical trial testing the efficacy of a calcium phosphate mouth rinse (Caphosol s ) with fluoride treatments vs a standard regimen of fluoride rinsing and placebo tray treatments in 95 patients undergoing hematopoietic stem cell transplantation (HSCT). The days and severity of mucositis were prospectively evaluated. There were statistically significant decreases in days of mucositis (3.72 vs 7.22 P ¼ 0.001), duration of pain (2.86 vs 7.67, P ¼ 0.0001), dose of morphine (34.54 mg vs 122.78 mg), days of morphine (1.26 vs 4.02, P ¼ 0.0001) and days to the onset of engraftment ANC (absolute neurotrophil count)4200 mm 3 (11.12 vs 12.56) in the Caphosol s and fluoride treatment group vs fluoriderinse group, respectively. Caphosol s , a neutral, supersaturated, Ca 2+ /PO 4 3À mouth rinse, used in combination with topical fluoride treatments, is superior to fluoride rinse alone in reducing the frequency, intensity and duration of oral mucositis in patients undergoing HSCT.

Prophylaxis of Mucosal Toxicity by Oral Propantheline and Cryotherapy in Children with Malignancies Undergoing Myeloablative Chemo-Radiotherapy

“…When complicated with severe mucosal toxicity, increased risk of bleeding or infection as well as oral and abdominal pain, which may lead to apoclesis, is the major concern for immunosuppressive and myelosuppressive patients undergoing MCT/ PBSC. There have been many reports on the decreasing incidence of chemotherapy-or radiation-induced mucosal toxicity by using the agents such as alloprinol (Howell et al 1981), leaser treatment (Barasch et al 1995;Wong and WilderSmith 2002), oral glutamine (Skubitz and Anderson 1996), tretinoin cream (Cohen et al 1997), granulocyte-macrophage colony-stimulating factor (Rosso et al 1997), recombinant human keratinocyte growth factor (Meropol et al 2003), and calcium phosphate mouth rinse (Papas et al 2003). In most cases, however, these methods may not be suitable for younger children and their cost-benefit may not be as good as expected.…”

Phase II Multicenter Trial of Caphosol for the Reduction of Mucositis in Patients Receiving Radiation Therapy for Head and Neck Cancer

“…While its effectiveness has been documented in patients with hematological malignancies undergoing stem cell transplant, there have been no prospective evaluations in radiotherapyrelated mucositis of the head and neck region [9]. The purpose of this study was to estimate the effect of Caphosol on the incidence of oral mucositis in patients receiving radiation therapy with or without systemic therapy for the treatment of head and neck cancer and to correlate the extent of mucosal injury and components of WHO mucositis data with clinical outcomes (including oral intake, swallowing function, and pain), and patient preference.…”

Evidence based complementary and alternative methods used in the prevention and treatment of oral mucositis in cancer:Literature review

“…Kanserde Destek Bakım Çok Uluslu Birliği (MASCC) ve Uluslararası Oral Onkoloji Birliği (ISOO) uzmanları mukozitin önlenmesi, değerlendirilmesi ve tedavisi için klinik uygulama rehberleri geliştirmiştir. Bu rehberler oral mukoziti önlemek ya da şiddetini hafifletmek için büyüme faktörü (palifermin) [9,12,13,14,15], oral kriyoterapi [16,17,18,19] ve düşük enerjili lazer uygulamasını önermektedir [9,13,14]. Oral mukozitin çözümünde geleneksel tıbbı tedavinin sınırlı etkinliği nedeniyle kanser hastaları sıklıkla tamamlayıcı ve alternatif tedavi (TAT) yöntemlerine başvurmaktadır [6,20].…”

“…Son dönemde bilimsel kanıtlar bal, arı sütü ve propolis gibi bal ürünlerinin antiinflamatuvar, antioksidan ve antimikrobiyal özellikleri nedeniyle oral mukozitin önlenmesinde ve tedavisinde kullanımını önermektedir [6,11,22]. Sıklıkla kullanılan diğer TAT yöntemleri ise kriyoterapi [16,17,18,19] ve sakız çiğnemedir [10,4]. TAT yöntemlerinin başarılı olabilmesi için sağlık ekibi üyelerinin bu uygulamalardan haberdar olması, hastaların zarar görmesinin engellenmesi ve bu yöntemlerden kanıta dayalı olanların tercih edilmesi konusunda hastalara rehberlik yapılması son derece önemlidir [1].…”