Prospective Oral Mucositis Audit: Oral Mucositis in Patients Receiving High-Dose Melphalan or BEAM Conditioning Chemotherapy—European Blood and Marrow Transplantation Mucositis Advisory Group

Abstract

Severe OM is more common in the transplantation setting than previously reported, justifying effective preventative and therapeutic measures.

The Prospective Oral Mucositis Audit: relationship of severe oral mucositis with clinical and medical resource use outcomes in patients receiving high-dose melphalan or BEAM-conditioning chemotherapy and autologous SCT

“…The first part of the analysis (described in our initial paper) revealed a high incidence of severe (World Health Organization (WHO) oral toxicity scale grade 3-4) 11 OM (44%) in patients with multiple myeloma (MM) or non-Hodgkin's lymphoma (NHL) who underwent high-dose dose melphalan or BEAM conditioning, respectively and autologous SCT. 1 Severe OM risk and/or duration were significantly associated with higher chemotherapy dose per kg body weight and poor performance status, but in contrast to some previous reports they were not related to age.…”

“…1 This second analysis of data from this pan-European audit provides new insights into the clinical sequelae of severe OM and associated medical resource use. Consistent with other observations, 8,13 we found that severe OM was closely related to development of fever, with the incidence of fever being 21% higher and the duration of fever 1.2 days longer, in those with severe OM.…”

“…This observation was confirmed when time to neutrophil engraftment was tentatively allowed as an additional covariate in the multivariate analysis of severe OM duration (Po0.001), as noted in our earlier analysis. 1 Length of hospital stay Length of hospital stay increased with increasing severity of OM in patients with MM, ranging from 17.0±5.4 days in patients with no OM to 21.5 ± 3.7 days in patients with grade 4 OM, with severe OM prolonging hospital stay by 2.3 days (P ¼ 0.013). However this trend was less clear in patients with NHL, who tended to have a longer hospital stay than patients with MM (Table 2).…”

“…1 In brief, this prospective, observational audit recruited 197 adult patients with MM or NHL who received highdose melphalan (200 mg/m 2 ; MM patients) or BEAM (carmustine 300 mg/m 2 , etoposide 800 mg/m 2 , cytarabine 800-1600 mg/m 2 and melphalan 140 mg/m 2 ; NHL patients) conditioning chemotherapy followed by autologous SCT. Exclusion criteria were previous SCT/BMT, palifermin administration and presence of oral abnormalities at baseline.…”

“…Oral mucositis (OM) is a very common debilitating adverse event in patients receiving high-dose chemotherapy and SCT, 1 and results from damage to both epithelial and submucosal tissues by the conditioning regimen. 2 Clinical manifestations of OM include signs and symptoms of an inflammatory process, ranging from mild erythema, oedema and soreness to extreme pain and ulceration.…”