Oral cryotherapy for the prevention of high-dose melphalan-induced stomatitis in allogeneic hematopoietic stem cell transplant recipients

Aisa, Yoshinobu; Mori, Takehiko; Kudo, M.; Yashima, T.; Kondo, Sakiko; Yokoyama, Akihiro; Ikeda, Yasuo; Okamoto, Shinichiro

doi:10.1007/s00520-004-0726-y

Cited by 62 publications

(42 citation statements)

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“…This suggestion is based on two case series [16,20], four non-randomized clinical trials [14,15,19,21], and three RCTs [17, 18; 22 supplemented by 23] (Table 2). The collective evidence was scored as level III.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of oral cryotherapy for management of oral mucositis caused by cancer therapy

Peterson

Öhrn

Bowen

et al. 2012

Support Care Cancer

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115

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Purpose This systematic review analyzed the strength of the literature and defined clinical practice guidelines for the use of oral cryotherapy for the prevention and/or treatment of oral mucositis caused by cancer therapy. Methods A systematic review on relevant oral cryotherapy studies indexed prior to 31 December 2010 was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO) using OVID/MEDLINE, with publications selected for review based on defined inclusion and exclusion criteria. Findings from the reviewed studies were integrated into guidelines based on the overall level of evidence for each intervention. Guidelines were classified into three types: recommendation, suggestion, or no guideline possible. of oral cryotherapy to prevent oral mucositis in patients receiving high-dose melphalan as conditioning regimen with or without total body irradiation for HCST was revised from the 2007 guidelines. No guideline was possible for any other intervention, due to insufficient evidence. Conclusions The evidence continues to support the use of oral cryotherapy for prevention of oral mucositis in patients receiving bolus 5-FU chemotherapy or high-dose melphalan. This intervention is consistent with the MASCC/ISOO guidelines published in 2007. The literature is limited by the fact that utilization of a double-blind study design is not feasible. Future studies that compare efficacy of oral cryotherapy with other mucositis agents in patients receiving chemotherapy with relatively short plasma half-lives would be useful.

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Section: Resultsmentioning

confidence: 99%

Systematic review of oral cryotherapy for management of oral mucositis caused by cancer therapy

Peterson

Öhrn

Bowen

et al. 2012

Support Care Cancer

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115

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“…The administration of lenograstim at a dose of 5 mg/kg was initiated 1 day after HSCT and continued until neutrophil recovery was achieved. After April 2003, oral cryotherapy was applied for the prophylaxis of oral mucositis due to high-dose melphalan as we previously described [21,22].…”

Section: Methodsmentioning

confidence: 99%

Long‐term follow‐up of reduced‐intensity allogeneic hematopoietic stem cell transplantation for refractory or relapsed follicular lymphoma

Ono¹,

Mori²,

Kato³

et al. 2012

American J Hematol

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Although allogeneic hematopoietic stem cell transplantation (HSCT) is considered the only curative treatment for refractory or relapsed follicular lymphoma (FL), transplant-related mortality (TRM) greatly interferes with the success. A variety of reduced-intensity conditionings (RICs) have been used to reduce TRM, but an optimal conditioning for FL has not been fully established. We retrospectively evaluated the outcome of allogeneic HSCT for FL with RIC consisting of fludarabine and melphalan. Nineteen adult patients with relapsed or refractory FL were conditioned with fludarabine (125 mg/m 2 ) and melphalan (140 mg/m 2 ), and received grafts from an HLA-identical sibling (n 5 6) or an unrelated donor (n 5 13). For the prophylaxis of graft-versus-host disease (GVHD), cyclosporine A or tacrolimus with short-term methotrexate was given. There were no early deaths before engraftment, and all patients achieved engraftment. Three patients died of extensive-type chronic GVHD (n 5 2) or bacterial infection (n 5 1) without disease progression. With a median follow-up period of 75.2 months (range: 33.3-111.9 months), 16 patients were alive without disease progression. Both the 5-year overall and progression-free survival rates were 84.2% (95% CI: 67.7-100%). These results strongly suggest that allogeneic HSCT with RIC using fludarabine and melphalan could be a promising treatment choice for refractory or relapsed FL. Current chemotherapies, such as rituximab-containing regimens, have improved the prognosis of follicular lymphoma (FL). However, FL is generally considered incurable with these conventional treatments, and the disease relapses in most patients [1]. High-dose chemotherapy with autologous or allogeneic hematopoietic stem cell transplantation (HSCT) has been shown to improve the survival rates of relapsed or refractory FL [2,3]. When compared with autologous HSCT, a significant reduction in relapse rate has been observed after allogeneic HSCT with myeloablative conditioning [4][5][6]. The suggested mechanism of the reduced relapse rate is the graft-versus-lymphoma (GVL) effect provided by transplanted donor cells. However, this favorable effect is often offset by the high transplantrelated mortality (TRM) of allogeneic HSCT following myeloablative conditioning. To reduce TRM, most of the recent studies have focused on the use of reduced-intensity conditioning (RIC). The outcomes are promising and the practice of allogeneic HSCT has shifted in favor of RIC, although registry data showed an increased risk of late disease progression after RIC regimens [7,8]. The definition of RIC included a variety of regimens which varied significantly in their intensity and immunosuppressive effects. Thus, the optimal RIC regimens of allogeneic HSCT for FL have yet to be established, and long-term follow-up is also lacking in most of the earlier studies. Therefore, we retrospectively evaluated the long-term outcome of allogeneic HSCT with RIC consisting of fludarabine and melphalan for relapsed or refractory FL.Nineteen patien...

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“…[1][2][3] OM is a significant posttransplant complication, and together with gut tissue damage and inflammation, caused by conditioning regimens, contributes to the development and pathogenesis of acute GVHD. [4][5][6] The incidence of acute GVHD varies between 28 and 45% in the Flu/Mel-reduced intensity conditioning regimen comprising of fludarabine total dose 125-150 mg/m 2 and melphalan total dose 140-180 mg/m 2 .…”

mentioning

confidence: 99%

“…[4][5][6] The incidence of acute GVHD varies between 28 and 45% in the Flu/Mel-reduced intensity conditioning regimen comprising of fludarabine total dose 125-150 mg/m 2 and melphalan total dose 140-180 mg/m 2 . 1,[7][8][9] We decided to analyze the impact of reduced OM incidence (reduced oral tissue damage) on acute GVHD, and analyzed 142 prospectively observed patients after Flu/Mel (fludarabine 30 mg/m 2 i.v. once daily for 4 days, melphalan 140 mg/m 2 i.v.…”

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confidence: 99%

Oral cryotherapy can significantly reduce oral mucositis but not acute GVHD incidence in Flu/Mel conditioning allo-SCT

Vokurka

Svoboda

Jungová

et al. 2011

Bone Marrow Transplant

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influenced the detailed results of our analysis: more peripheral SC grafts and lower MTX dose administered in the non-cryotherapy group, fewer sibling donor transplantations in cryotherapy group, some patients lost from observation for mortality reasons before day þ 100 without developing acute GVHD. We assume, however, that our findings are potent enough to state, that even although oral cryotherapy significantly reduced OM, it had no impact on acute GVHD incidence reduction. Our findings do not exclude OM from the acute GVHD pathogenesis, but its role appears less significant compared with other possible factors. To get more precise results, a large study comparing the extent of gut damage, OM and acute GVHD characteristics would be needed.

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Oral cryotherapy for the prevention of high-dose melphalan-induced stomatitis in allogeneic hematopoietic stem cell transplant recipients

Abstract: These results suggested that oral cryotherapy could effectively prevent stomatitis caused by high-dose melphalan, and we recommend that it should be incorporated into the conditioning regimen with high-dose melphalan.

Cited by 62 publications

References 10 publications

Systematic review of oral cryotherapy for management of oral mucositis caused by cancer therapy

Systematic review of oral cryotherapy for management of oral mucositis caused by cancer therapy

Long‐term follow‐up of reduced‐intensity allogeneic hematopoietic stem cell transplantation for refractory or relapsed follicular lymphoma

Oral cryotherapy can significantly reduce oral mucositis but not acute GVHD incidence in Flu/Mel conditioning allo-SCT

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