A longitudinal study of oral ulcerative mucositis in bone marrow transplant recipients

Abstract

Background. Few longitudinal studies have investigated the onset, duration, and resolution of ulcerative mucositis in bone marrow transplant recipients. This study prospectively followed a group of such patients on a daily basis to obtain data on the incidence of ulcerative mucositis, location and duration of lesions, severity with different conditioning regimens, and the relationship of such mucositis to the absolute neutrophil count. Methods. Fifty‐nine bone marrow transplant recipients on prophylactic acyclovir were examined daily for 26 days after marrow infusion, and all oral ulcerative lesions were recorded. Results. Oral ulcers occurred in 76.3% of patients, began at a mean of 5 days after marrow infusion (day + 5), and lasted for a median of 6 days. More than 90% of patients showed complete resolution of ulcers on or before day + 15, and all showed resolution when the absolute neutrophil count was > 500 cells/ml. Persistence of ulcers was noticed in patients who had oral graft‐versus‐host disease and in some patients who initially developed more severe ulcerations. Ninety‐six percent of ulcers were located on nonkeratinized mucosa. Conclusions. Ulcerative mucositis occurs in about 75% of bone marrow transplant recipients in the absence of herpes simplex virus infection. Most lesions occur on nonkeratinized mucosae which are vulnerable to trauma, especially if such mucosae are rendered atrophic by conditioning regimens. Oral ulcers may persist beyond day + 15 and after recovery of the neutrophil count in patients who initially develop more severe ulcerations or in patients who develop graft‐versus‐host disease.

Reliability and validity of a patient self-administered daily questionnaire to assess impact of oral mucositis (OM) on pain and daily functioning in patients undergoing autologous hematopoietic stem cell transplantation (HSCT)

“…Patient-reported scores of OM severity peaked around day 5 while scores measured using the WHO, RTOG, and WCCNR scales did not peak until day 7, both of which are consistent with previous longitudinal studies of the time course of OM after HSCT. 2,4 Significantly, patients using the OMDQ often detected changes in and progression of OM severity 1-3 days earlier than clinical personnel who used the WHO scale. These results strongly suggest that the MTS components of the OMDQ may enable earlier detection of OM and may lead to changes in therapy, including earlier initiation of analgesics.…”

“…1 Almost all patients experience some degree of OM after myeloablative therapy and BMT and approximately 75% have oral ulcers within 3-5 days after BMT. [2][3][4] OM is a result of a complex cascade of physiological events. 5 Damage from radiotherapy and chemotherapy to the rapidly dividing tissues that comprise the mucosal epithelium of the mouth and throat is followed by upregulation of transcription factors and proinflammatory cytokines in the submucosa, in turn leading to oral ulceration.…”

The Prospective Oral Mucositis Audit: relationship of severe oral mucositis with clinical and medical resource use outcomes in patients receiving high-dose melphalan or BEAM-conditioning chemotherapy and autologous SCT

“…This supports previous observations that healing of OM coincides with neutrophil recovery. [20][21][22][23] Although some investigators have failed to find a link between OM and neutropenia, 5,24 Rapoport et al 25 noted that duration of neutropenia was a risk factor for OM and the severity of OM has been linked to the degree of neutropenia. 26 Oral neutrophil kinetic studies (using mouth rinses) in patients recovering from profound neutropenia have demonstrated that neutrophils are present in the tissues before peripheral neutrophil counts recover, 21,27,28 consistent with their important role in mucosal defence and repair.…”

Treatment-induced mucositis: an old problem with new remedies

“…As in the case of patients with oral cancer, immunosuppressed patients have an increased frequency of carriage of aerobic Gram-negative bacteria and fungi (Woo et al, 1993). The use of prophylactic antibiotics (Meissenberg et al, 1996) certainly reduces the incidence of fever and bacteraemia in this group of patients, but the impact on mucositis is less well documented.…”