Five-year follow-up of survival and relapse in patients who received cryotherapy during high-dose chemotherapy for stem cell transplantation shows no safety concerns

Context Conventional chemotherapy leads to multiple adverse mucocutaneous complications including oral mucositis, alopecia, ocular toxicity, and onycholysis. Limited pharmacologic interventions are available for preventing these clinical problems. Objectives This study aimed to critically review the role of cryotherapy (regional hypothermia) for alleviating these adverse symptoms. Methods A narrative review was performed, with an emphasis on randomized controlled trials. A comprehensive search using PubMed, Ovid, Embase, and MEDLINE® was completed. References of all cited articles also were reviewed. Data from the review were comprised of articles published between 1970 to May 2013. Results Available evidence suggests that regional hypothermia decreases the burden of chemotherapy-related oral mucositis, alopecia, ocular toxicity, and onycholysis. The major limitations of studies include the absence of blinded control groups and variable clinical endpoints. Conclusion Regional hypothermia decreases the burden of these four chemotherapy-induced complications and is well tolerated. More research is needed to determine what subgroups of cancer patients are most likely to respond to different types of regional hypothermia, the ideal duration of cooling needed, and to further improve the ease of use of the cooling devices.

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“…A recent report found no serious adverse effects such as an increased relapse rate in hematological cancers over a five-year period. 40 …”

Section: Oral Mucositismentioning

confidence: 99%

Supportive Cryotherapy: A Review From Head to Toe

Kadakia

Rozell

Butala

et al. 2014

Journal of Pain and Symptom Management

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“…Three studies each came from Iran, Italy, and Sweden; two from Turkey; one study each from Canada, Denmark, Greece, and the United States. From Sweden, Svanberg, Ohrn, and Birgegård () reported the results from a single study at three time points in 2007, 2010, and 2012, from the same patient group. However, we included all of these because each paper presented different outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Patients experienced cryotherapy under following conditions. First, eight studies (Askarifar et al, ; Gori et al, 2017; Lilleby et al, ; Marchesi et al, ; Salvador et al, ; Svanberg, Birgegard, & Ohrn, ; Svanberg, Ohrn, & Birgegard, ; Svanberg et al, ) targeted patients receiving high‐dose chemotherapy before blood stem cell transplantation in haematology malignancies. Second, six studies (Cascinu et al, ; Heydari, Shaifi, & Salek, ; Karagozoglu & Filiz Ulusoy, ; Katranci, Ovayolu, Ovayolu, & Sevinc, ; Papadeas et al, ; Sorensen et al, ) focused on general chemotherapy in solid tumours such as gastric and colorectal cancers.…”

Section: Resultsmentioning

confidence: 99%

“…Patients experienced cryotherapy under following conditions. First, eight studies (Askarifar et al, 2016;Gori et al, 2017;Lilleby et al, 2006;Marchesi et al, 2017;Salvador et al, 2012;Svanberg, Birgegard, & Ohrn, 2007;Svanberg, Ohrn, & Birgegard, 2010;Svanberg et al, 2012) targeted patients receiving high-dose…”

Section: General Characteristics Of Selected Studiesmentioning

confidence: 99%

“…Anti-cancer drugs used before blood stem cell transplantation were often melphalan (Askarifar et al, 2016;Lilleby et al, 2006;Marchesi et al, 2017;Salvador et al, 2012), and a mixture of melphalan and busulfan was partly used in some studies (Svanberg et al, 2007;Svanberg et al, 2010;Svanberg et al, 2012). Only one study (Gori et al, 2017) used methotrexate (MTX).…”

Section: General Characteristics Of Selected Studiesmentioning

confidence: 99%

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Meta‐analysis of oral cryotherapy in preventing oral mucositis associated with cancer therapy

Park

Lee

2019

Int J of Nursing Practice

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Aims To review scientific evidence related to oral cryotherapy to prevent oral mucositis after cancer therapy. Background Oral mucositis is a common complication of cancer therapy. In the most severe form of oral mucositis, patients cannot eat or drink at all and must receive nutrition and fluid replacement through parenteral support. Topical cooling of the oral mucosa may be an option for the prevention of oral mucositis. Design Systematic review and meta‐analysis. Data sources The literature search was performed using the Ovid MEDLINE, Embase, Cochrane Library, and CINAHL Complete electronic databases for articles published up to 2017. The reference lists of all retrieved articles were manually reviewed to identify additional relevant studies. Results Of 353 publications, 15 randomized controlled trials, involving 919 cancer patients, conducted between 1994 and 2017 were included in the present meta‐analysis. Oral cryotherapy, applied during treatment of solid cancers, led to a statistically lower level (P < .05) of oral mucositis overall, and of the more severe grades (3‐4 and 2‐4). Conclusions Results of this study provide a scientific basis for oral cryotherapy as a viable nursing intervention that can significantly reduce the occurrence of severe oral mucositis.

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Equivalent chemotherapy efficacy against leukemia in mice treated with topical vasoconstrictors to prevent cancer therapy side effects

Graul-Conroy

Hicks

Fahl

2016

Intl Journal of Cancer

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Topically applied vasoconstrictor is a new strategy to prevent oral mucositis and alopecia, two complications of chemotherapy and stem-cell transplant. We sought to determine whether mice treated with topical vasoconstrictor minutes before chemotherapy to suppress L1210 leukemia would develop a vasoconstrictor-induced L1210 cell sanctuary, and with it, significantly worse survival outcomes. B6D2F1 mice received 10 4 mouse L1210 leukemia cells via retro-orbital intravenous injection and were then divided into treatment groups, which included: (i) no further treatment, (ii) a single, sub-curative, intraperitoneal dose of cyclophosphamide (90 mg/gm bw) 24 hr after L1210 cell inoculation, (iii) topical epinephrine (25-400 mM) to clipped dorsal backs 20 min before cyclophosphamide or (iv) orotopical phenylephrine (16-130 mM), epinephrine (10 mM) or norepinephrine (25 mM) 20 min before cyclophosphamide. All mice were then followed until day of death. Differences in median survival time and percent survival between mice receiving cyclophosphamide alone and mice treated with either orotopical phenylephrine, epinephrine or norepinephrine; or topical epinephrine before cyclophosphamide were not significantly different. A discernible leukemia sanctuary was not created by topical vasoconstrictor treatment prior to chemotherapy; there was no significant difference in leukemia progression between untreated mice and those treated with either orotopical or topical vasoconstrictor before chemotherapy. We have opened a Phase I/IIa dose escalation trial to evaluate the safety and efficacy of orotopical phenylephrine in preventing oral mucositis in subjects undergoing hematopoietic stem cell transplant conditioning with cyclophosphamide plus total body irradiation. This could provide a cost-effective and convenient method to prevent oral mucositis.

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Five-year follow-up of survival and relapse in patients who received cryotherapy during high-dose chemotherapy for stem cell transplantation shows no safety concerns

Cited by 13 publications

References 32 publications

Supportive Cryotherapy: A Review From Head to Toe

Supportive Cryotherapy: A Review From Head to Toe

Meta‐analysis of oral cryotherapy in preventing oral mucositis associated with cancer therapy

Equivalent chemotherapy efficacy against leukemia in mice treated with topical vasoconstrictors to prevent cancer therapy side effects

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