The Effect of Orally-Administered Zinc in the Prevention of Chemotherapy-Induced Oral Mucositis in Patients with Acute Myeloid Leukemia

Abstract

Background: Oral mucositis is a frequent yet serious adverse event associated with chemotherapy in acute myeloid leukemia. Although a wide spectrum of drugs has been tested for prophylaxis of oral mucositis, few of them are satisfactory. There is currently substantial clinical interest in zinc (Zn) as an antioxidant and a protective agent against chemotherapy -relatednormal tissue injury. Therefore, in the present study, we investigated whether zinc prevents oral mucositis associated with chemotherapy in patients with AML. Methods: A total of 140patients with AML were randomly selected and divided into two groups where the case groups received zinc sulfate 220 mg orally and the control groups received placeboes 3 times a day during their chemotherapy course. Data were analyzed by SPSS version 15 software. Mann-Whitney U test was used to evaluate mucositis, and pain intensity. Results: The incidence rates of mucositis were all markedly lower in oral zinc sulfate group than in control (P = 0.004). Conclusions: Zinc is available for preventing the complications of oral mucositis, and thus for improving patient quality of life.

Zinc Adequacy Is Essential for the Maintenance of Optimal Oral Health

“…A systematic review and meta-analysis of four randomized control trials that investigated the potential effects of zinc sulfate in the prevention of radiation-induced oral mucositis among patients suffering from head and neck cancers undergoing radiotherapy, revealed that zinc sulfate may not have the benefit of prophylaxis against radiation-induced oral mucositis in these patients [43]. Similar findings were obtained in other studies focused on the potential effects of zinc sulfate in the prevention of radiation-induced oral mucositis among patients suffering from head and neck cancers undergoing radiotherapy [42,43]. In a double-blind, randomized, placebo-controlled study in which patients were given 440 mg zinc sulfate daily or placebo for 3 weeks, Mansouri and colleagues did not find any significant association between zinc sulfate and prevention, reduction in intensity and duration of oral mucositis among patients undergoing high-dose chemotherapy [44].…”

“…They found that oral zinc sulfate may not produce any clinical effects either in preventing or reducing the incidence, alleviating pain intensity, or reducing the severity of chemotherapy-induced oral mucositis [41]. In a randomized trial including leukemia patients undergoing chemotherapy to investigate whether zinc prevented chemotherapy-induced oral mucositis, supplementation with zinc sulfate for a month was not found to be associated with decreased pain intensity [42]. A systematic review and meta-analysis of four randomized control trials that investigated the potential effects of zinc sulfate in the prevention of radiation-induced oral mucositis among patients suffering from head and neck cancers undergoing radiotherapy, revealed that zinc sulfate may not have the benefit of prophylaxis against radiation-induced oral mucositis in these patients [43].…”

“…Gholizadeh and colleagues, Arbabi-Kalati and colleagues as well as de Menêses also found a positive effect of zinc sulfate supplementation (ranging from 75 mg to 660 mg per day) on the reduction of oral mucositis incidence among patients suffering from acute myeloid leukemia undergoing chemotherapy in their randomized, double-blinded, placebo-controlled clinical trials. They concluded that zinc is a promising strategy for delaying the occurrence of chemotherapy-induced oral mucositis and reducing its intensity [42,46,47].…”

A Meta-Analysis on the Efficacy of Zinc in Oral Mucositis during Cancer Chemo and/or Radiotherapy—An Evidence-Based Approach

“…Commencement of zinc supplementation also varied among the studies. Five of the studies had initiated zinc therapy from the first day to the last day of cancer treatment (1,5,7,9,18). Three studies had employed different time intervals of zinc treatment ranging from 10 d prior to cancer therapy till 6 wk after cessation of the therapy (2-4).…”

“…According to recent MASCC/ISOO clinical guidelines, the various treatment modalities include oral cryotherapy, KGF-1 (human keratinocyte growth factor), and low-level laser therapy, which may aid in prevention of oral mucositis. Two percent morphine mouthwash, transdermal fentanyl patches and 0.5% doxepin mouthwash were also recommended for alleviation of pain (9)(10)(11).…”