The underlying mechanism of high-dose therapy (HDT)-related oral mucositis (OM) may be partly mediated by alterations in the normal salivary composition. This study evaluated salivary antioxidant and immunological capacities observed in myeloma patients suffering from HDTrelated OM, and assessed potential contribution of these factors to OM development. Twenty-five consecutive myeloma patients treated with melphalan 200 mg/m 2 followed by autologous SCT were enrolled. Patients underwent a daily assessment for OM, and salivary samples were collected on days À3 and þ 7 of transplantation and analyzed for secretory IgA and antioxidant capacity. The degree of mucosal damage was assessed by measuring the salivary carbonyl and albumin (Alb) levels. OM, reported in 96% of patients, appeared to be most severe on 8 day after transplantation (range: þ 2 to þ 14). Clinical mucositis was associated with significant reduction in salivary secretory IgA (54%; P ¼ 0.05), and antioxidant activity, measured by total antioxidant status (40%; P ¼ 0.0004), antioxidant capacity (ImAnOx) (23%; P ¼ 0.002) and uric acid level (51%; P ¼ 0.006). The increase found in salivary Alb (119%; P ¼ 0.024) and carbonyl (28%; P ¼ 0.047) levels, indicates mucosal and oxidative damage, respectively. These salivary changes might enhance mucositis development and symptoms. Therapeutic interventions, enhancing antioxidative and immunological activities need to be investigated.

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