Brief oral cryotherapy for the prevention of high-dose melphalan-induced stomatitis in allogeneic hematopoietic stem cell transplant recipients

Abstract

We previously reported the efficacy of oral cryotherapy for the prevention of high-dose melphalan-induced stomatitis. The purpose of this study was to evaluate whether the further shortening of the duration of oral cryotherapy could minimize its side effects while sparing its efficacy. Seventeen consecutive recipients of allogeneic hematopoieic stem cell transplant conditioned with high-dose melphalan in combination with fludarabine alone or with fludarabine and additional radiation were enrolled in the study. The severity of stomatitis was graded according to the National Cancer Institute-Common Toxicity Criteria. Patients were kept on oral cryotherapy shortly before, during, and for additional 30 min after the completion of melphalan administration (60-min oral cryotherapy). Patients who were also enrolled in our previous study received the same type of oral cryotherapy but for additional 90 min after the completion of melphalan administration (120-min oral cryotherapy), and they served as controls. Only 2 (11.8%) of 17 patients receiving 60-min oral cryotherapy and 2 (11.1%) of 18 patients receiving 120-min oral cryotherapy developed grade 2 or 3 stomatitis, respectively. The difference between groups was not statistically significant (P = 0.677). The incidence of unpleasant symptoms such as chills and nausea during oral cryotherapy decreased significantly with 60-min oral cryotherapy, as compared with that associated with 120-min oral cryotherapy (P < 0.01). These results suggest that 60-min oral cryotherapy is as effective as 120-min oral cryotherapy at preventing high-dose melphalan-induced stomatitis, and shorter treatment might have contributed to relieve patient discomfort during oral cryotherapy.

Long‐term follow‐up of reduced‐intensity allogeneic hematopoietic stem cell transplantation for refractory or relapsed follicular lymphoma

“…The administration of lenograstim at a dose of 5 mg/kg was initiated 1 day after HSCT and continued until neutrophil recovery was achieved. After April 2003, oral cryotherapy was applied for the prophylaxis of oral mucositis due to high-dose melphalan as we previously described [21,22].…”

Supportive Cryotherapy: A Review From Head to Toe

“…15, 16, 33-38 To address the optimal duration of cryotherapy in patients receiving melphalan, a study found that a total duration of cryotherapy for 60 minutes compared with 120 minutes improved tolerability without decreasing efficacy. 36 Other studies in patients undergoing HSCT have shown that oral cryotherapy also reduces opioid use 37 and decreases the need for parenteral nutrition. 38 …”

Oral cryotherapy reduces mucositis and opioid use after myeloablative therapy—a randomized controlled trial

“…Before BMT, patients are treated with myeloablative therapy, which reduces the renewal rate of the basal epithelium resulting in localised or diffuse ulceration of the mucosa and inflammation [2,8,13,24,26,27,31]. Chemotherapy has many adverse effects, among which oral symptoms and complications may be very severe [11,28].…”

“…The incidence of mucositis is up to 80% in BMT patients [14,16]. In a retrospective study, BMT patients with severe mucositis had an increased incidence of fever and infection and a fourfold increase in mortality [26]. Patients undergoing BMT have reported acute oral pain, mucositis and inability to eat as major sources of distress, and from the patient's perspective, oral mucositis is one of the most debilitating side effects of transplantation [2,9].…”