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CD34+ selection and the severity of oropharyngeal mucositis in total body irradiation-based allogeneic stem cell transplantation.
Support Care Cancer 2016; 24(2):815-822SC

Abstract

OBJECTIVE

The purpose of the present study was to evaluate the impact of ex vivo T cell depleted (TCD) by CD34+ selection on the incidence and severity of oropharyngeal mucositis (OM) after myeloablative allogeneic stem cell transplant (allo-SCT) with total body irradiation (TBI) conditioning. This approach has the advantage of avoiding methotrexate for graft versus host disease (GVHD) prophylaxis.

PATIENTS AND METHODS

We analyzed the incidence and severity of OM in a cohort of 105 consecutive patients who underwent CD34+ selected (peripheral blood stem cells (PBSCs) from human leukocyte antigen (HLA)-identical siblings) allo-SCT with total body irradiation (TBI) conditioning. OM was graded by the World Health organization (WHO) and the Bearman regimen-related toxicity (RRT) scales.

RESULTS

The incidence of WHO grade 3-4 OM was 34.3 %. There were no cases of grade 3-4 OM by the RRT scale. Significant correlation was found between the severity of OM and the use of intravenous (IV) narcotic medications (r (2) = 0.15, p = 0.004), total parenteral nutrition (TPN; r (2) = 0.68, p < 0.001), and hospital length of stay (LOS) (r (2) = 0.12, p = 0.01).

DISCUSSION

TBI-induced OM can inflict significant morbidity in the early transplant period, and the incidence of WHO grade 3-4 OM can exceed 50 % when methotrexate is used for GVHD prophylaxis. In the CD34+ selected setting, methotrexate is avoided and the incidence of WHO grade 3-4 OM, use of TPN, and need for narcotic analgesia appear to be lower than historic evidence from standard T-replete allogeneic transplantation.

CONCLUSION

We conclude that toxicity from OM is tolerable in CD34+ selected allo-SCT and should be prospectively measured in randomized trials comparing CD34+ selection versus T-replete transplantation.

Authors+Show Affiliations

Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA.Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA.Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA. minoo.battiwalla@nih.gov.

Pub Type(s)

Journal Article
Research Support, N.I.H., Intramural

Language

eng

PubMed ID

26190358

Citation

Anand, Ankit, et al. "CD34+ Selection and the Severity of Oropharyngeal Mucositis in Total Body Irradiation-based Allogeneic Stem Cell Transplantation." Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, vol. 24, no. 2, 2016, pp. 815-822.
Anand A, Anandi P, Jain NA, et al. CD34+ selection and the severity of oropharyngeal mucositis in total body irradiation-based allogeneic stem cell transplantation. Support Care Cancer. 2016;24(2):815-822.
Anand, A., Anandi, P., Jain, N. A., Lu, K., Dunavin, N., Hourigan, C. S., ... Battiwalla, M. (2016). CD34+ selection and the severity of oropharyngeal mucositis in total body irradiation-based allogeneic stem cell transplantation. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 24(2), pp. 815-822. doi:10.1007/s00520-015-2848-9.
Anand A, et al. CD34+ Selection and the Severity of Oropharyngeal Mucositis in Total Body Irradiation-based Allogeneic Stem Cell Transplantation. Support Care Cancer. 2016;24(2):815-822. PubMed PMID: 26190358.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CD34+ selection and the severity of oropharyngeal mucositis in total body irradiation-based allogeneic stem cell transplantation. AU - Anand,Ankit, AU - Anandi,Prathima, AU - Jain,Natasha A, AU - Lu,Kit, AU - Dunavin,Neil, AU - Hourigan,Christopher S, AU - Le,Robert Q, AU - Chokshi,Puja D, AU - Ito,Sawa, AU - Stroncek,David F, AU - Sabatino,Marianna, AU - Barrett,A John, AU - Battiwalla,Minoo, Y1 - 2015/07/21/ PY - 2015/03/09/received PY - 2015/07/06/accepted PY - 2015/7/21/entrez PY - 2015/7/21/pubmed PY - 2016/8/10/medline KW - Allogeneic KW - CD34 selection KW - Methotrexate KW - Oral mucositis KW - Oropharyngeal mucositis KW - Quality of life KW - Stem cell transplant KW - T cell depleted transplantation KW - Total body irradiation SP - 815 EP - 822 JF - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer JO - Support Care Cancer VL - 24 IS - 2 N2 - OBJECTIVE: The purpose of the present study was to evaluate the impact of ex vivo T cell depleted (TCD) by CD34+ selection on the incidence and severity of oropharyngeal mucositis (OM) after myeloablative allogeneic stem cell transplant (allo-SCT) with total body irradiation (TBI) conditioning. This approach has the advantage of avoiding methotrexate for graft versus host disease (GVHD) prophylaxis. PATIENTS AND METHODS: We analyzed the incidence and severity of OM in a cohort of 105 consecutive patients who underwent CD34+ selected (peripheral blood stem cells (PBSCs) from human leukocyte antigen (HLA)-identical siblings) allo-SCT with total body irradiation (TBI) conditioning. OM was graded by the World Health organization (WHO) and the Bearman regimen-related toxicity (RRT) scales. RESULTS: The incidence of WHO grade 3-4 OM was 34.3 %. There were no cases of grade 3-4 OM by the RRT scale. Significant correlation was found between the severity of OM and the use of intravenous (IV) narcotic medications (r (2) = 0.15, p = 0.004), total parenteral nutrition (TPN; r (2) = 0.68, p < 0.001), and hospital length of stay (LOS) (r (2) = 0.12, p = 0.01). DISCUSSION: TBI-induced OM can inflict significant morbidity in the early transplant period, and the incidence of WHO grade 3-4 OM can exceed 50 % when methotrexate is used for GVHD prophylaxis. In the CD34+ selected setting, methotrexate is avoided and the incidence of WHO grade 3-4 OM, use of TPN, and need for narcotic analgesia appear to be lower than historic evidence from standard T-replete allogeneic transplantation. CONCLUSION: We conclude that toxicity from OM is tolerable in CD34+ selected allo-SCT and should be prospectively measured in randomized trials comparing CD34+ selection versus T-replete transplantation. SN - 1433-7339 UR - https://www.unboundmedicine.com/medline/citation/26190358/CD34+_selection_and_the_severity_of_oropharyngeal_mucositis_in_total_body_irradiation_based_allogeneic_stem_cell_transplantation_ L2 - https://dx.doi.org/10.1007/s00520-015-2848-9 DB - PRIME DP - Unbound Medicine ER -