The Incidence of Severe Oral Mucositis and Taste Disturbance in Patients Undergoing Different Conditioning Regimens in Haematopoietic Stem Cell Transplantation

Abstract

PurposeOral mucositis and taste disturbance are common complications during haematopoietic stem cell transplantation (HSCT). This study aimed to review the incidence of severe mucositis and taste disturbance in patients undergoing different HSCT regimens. MethodsThis single-centre retrospective study reviewed daily oral assessment for 467 consecutive patients who underwent different transplant regimens for matched unrelated or related allogeneic HSCT with post-transplant methotrexate, haploidentical or mismatched HSCT with post-transplant cyclophosphamide (PTCy), or autologous HSCT. Oral care and cryotherapy with melphalan were used. Patient demographic data, oral mucositis WHO grade, taste disturbance, use of total parenteral nutrition (TPN) and patient-controlled analgesia (PCA) were collected. ResultsGrade 3-4 oral mucositis was common in myeloablative total body irradiation (TBI) based regimens cyclophosphamide/ TBI (CyTBI) (71%) and fludarabine/ TBI (FluTBI) with PTCy (46%), as well as reduced intensity fludarabine/ melphalan (FluMel) (43%) and carmustine/ etoposide/ cytarabine/ melphalan (BEAM) autologous HSCT (41%). In contrast, Grade 3-4 oral mucositis was less common in reduced intensity haploidentical regimen melphalan/ fludarabine/ TBI with PTCy (19%), all non-myeloablative regimens (0-9%) and high dose melphalan autologous HSCT (26%). TPN and PCA use were correlated to oral mucositis severity. Taste disturbance was common regardless of the regimens (89%, range 71-95%). ConclusionsSevere oral mucositis was associated with myeloablative TBI, methotrexate and melphalan in combination with methotrexate and in BEAM. Use of PTCy was preferable over methotrexate to prevent oral mucositis.