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Prospective evaluation of oral mucositis in patients receiving myeloablative conditioning regimens and haemopoietic progenitor rescue.

Abstract

Four hundred and twenty-nine patients received myeloablative chemotherapy for solid and haematological malignancies in a bone marrow transplantation unit. Regimens appropriate to the tumour type were administered and haemopoietic reconstitution was achieved with peripheral blood progenitor cells (PBPC; n = 275), autologous bone marrow (auto-BMT; n = 69) or allogeneic bone marrow (allo-BMT; n = 85). World Health Organization (WHO) oral mucositis scores were collected prospectively from the start of chemotherapy (d 1) until d 28 or discharge. Oral mucositis (OM) was experienced by 425 (99%) patients and in 289 (67.4%) this was grade III or IV. Strong opiate analgesia was prescribed for a median of 6 d to 47% of patients. Univariate analysis suggested that the area under the OM curve (AUC; sum of daily mucositis grades, d 1-28) was associated with the myeloablative regimen, haemopoietic progenitor source (PBPC > allo-BMT > auto-BMT), use of myeloid growth factors and age. Multivariate analysis showed that the only independent risk factor for mucositis was the conditioning regimen (P < 0.00005). The mean OM AUC for high-dose melphalan (HDM) regimens (52 grade-days) exceeded busulphan (41), busulphan-cyclophosphamide (35), cyclophosphamide-total body irradiation (TBI) (34), cyclophosphamide-carmustine (BCNU) (20) and cyclophosphamide-etoposide-carmustine (CVB) (19). HDM regimens resulted in the highest mean peak OM (3.6), followed by busulphan regimens (2.6), cyclophosphamide/TBI (2.3) and cyclophosphamide-carmustine and CVB (1.4). Busulphan produced significantly delayed OM (median 3 d; P < 0.00005). There was a linear association between the area under the OM curve for each treatment group and the time to reach grade 3 OM (P < 0.00005), but no association with the time to reach grade 4 neutropenia (P = 0.24) or thrombocytopenia (P = 0.73), implying that haematological and mucosal toxicity are not associated. The cytotoxic regimen is the most significant determinant of OM. Studies investigating agents to ameliorate mucosal toxicity should be stratified according to cytotoxic regimen.

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  • Authors+Show Affiliations

    ,

    Cancer Research Campaign Department of Medical Oncology, Christie Hospital NHS Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK.

    , , , , , ,

    Source

    British journal of haematology 110:2 2000 Aug pg 292-9

    MeSH

    Adolescent
    Adult
    Age Factors
    Aged
    Analgesics, Opioid
    Antineoplastic Agents, Alkylating
    Area Under Curve
    Bone Marrow Transplantation
    Female
    Growth Substances
    Hematopoietic Stem Cell Transplantation
    Humans
    Male
    Middle Aged
    Mouth Mucosa
    Multivariate Analysis
    Myeloablative Agonists
    Pain
    Prospective Studies
    Stomatitis
    Transplantation, Autologous
    Transplantation, Homologous

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    10971384

    Citation

    Wardley, A M., et al. "Prospective Evaluation of Oral Mucositis in Patients Receiving Myeloablative Conditioning Regimens and Haemopoietic Progenitor Rescue." British Journal of Haematology, vol. 110, no. 2, 2000, pp. 292-9.
    Wardley AM, Jayson GC, Swindell R, et al. Prospective evaluation of oral mucositis in patients receiving myeloablative conditioning regimens and haemopoietic progenitor rescue. Br J Haematol. 2000;110(2):292-9.
    Wardley, A. M., Jayson, G. C., Swindell, R., Morgenstern, G. R., Chang, J., Bloor, R., ... Scarffe, J. H. (2000). Prospective evaluation of oral mucositis in patients receiving myeloablative conditioning regimens and haemopoietic progenitor rescue. British Journal of Haematology, 110(2), pp. 292-9.
    Wardley AM, et al. Prospective Evaluation of Oral Mucositis in Patients Receiving Myeloablative Conditioning Regimens and Haemopoietic Progenitor Rescue. Br J Haematol. 2000;110(2):292-9. PubMed PMID: 10971384.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prospective evaluation of oral mucositis in patients receiving myeloablative conditioning regimens and haemopoietic progenitor rescue. AU - Wardley,A M, AU - Jayson,G C, AU - Swindell,R, AU - Morgenstern,G R, AU - Chang,J, AU - Bloor,R, AU - Fraser,C J, AU - Scarffe,J H, PY - 2000/9/6/pubmed PY - 2000/10/7/medline PY - 2000/9/6/entrez SP - 292 EP - 9 JF - British journal of haematology JO - Br. J. Haematol. VL - 110 IS - 2 N2 - Four hundred and twenty-nine patients received myeloablative chemotherapy for solid and haematological malignancies in a bone marrow transplantation unit. Regimens appropriate to the tumour type were administered and haemopoietic reconstitution was achieved with peripheral blood progenitor cells (PBPC; n = 275), autologous bone marrow (auto-BMT; n = 69) or allogeneic bone marrow (allo-BMT; n = 85). World Health Organization (WHO) oral mucositis scores were collected prospectively from the start of chemotherapy (d 1) until d 28 or discharge. Oral mucositis (OM) was experienced by 425 (99%) patients and in 289 (67.4%) this was grade III or IV. Strong opiate analgesia was prescribed for a median of 6 d to 47% of patients. Univariate analysis suggested that the area under the OM curve (AUC; sum of daily mucositis grades, d 1-28) was associated with the myeloablative regimen, haemopoietic progenitor source (PBPC > allo-BMT > auto-BMT), use of myeloid growth factors and age. Multivariate analysis showed that the only independent risk factor for mucositis was the conditioning regimen (P < 0.00005). The mean OM AUC for high-dose melphalan (HDM) regimens (52 grade-days) exceeded busulphan (41), busulphan-cyclophosphamide (35), cyclophosphamide-total body irradiation (TBI) (34), cyclophosphamide-carmustine (BCNU) (20) and cyclophosphamide-etoposide-carmustine (CVB) (19). HDM regimens resulted in the highest mean peak OM (3.6), followed by busulphan regimens (2.6), cyclophosphamide/TBI (2.3) and cyclophosphamide-carmustine and CVB (1.4). Busulphan produced significantly delayed OM (median 3 d; P < 0.00005). There was a linear association between the area under the OM curve for each treatment group and the time to reach grade 3 OM (P < 0.00005), but no association with the time to reach grade 4 neutropenia (P = 0.24) or thrombocytopenia (P = 0.73), implying that haematological and mucosal toxicity are not associated. The cytotoxic regimen is the most significant determinant of OM. Studies investigating agents to ameliorate mucosal toxicity should be stratified according to cytotoxic regimen. SN - 0007-1048 UR - https://www.unboundmedicine.com/medline/citation/10971384/Prospective_evaluation_of_oral_mucositis_in_patients_receiving_myeloablative_conditioning_regimens_and_haemopoietic_progenitor_rescue_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0007-1048&amp;date=2000&amp;volume=110&amp;issue=2&amp;spage=292 DB - PRIME DP - Unbound Medicine ER -