CD34+ selection and the severity of oropharyngeal mucositis in total body irradiation-based allogeneic stem cell transplantation

Abstract

Objective To evaluate the impact of ex vivo T cell depleted (TCD) by CD34+ selection on the incidence and severity of Oropharyngeal mucositis (OM) in 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 (PBSC (peripheral blood stem cells) from 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 (r2=0.15, p=0.004), Total parenteral nutrition (TPN) (r2=0.68, p<0.001) and hospital length of stay (LOS) (r2=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.

Burden of Oral Mucositis: A Systematic Review and Implications for Future Research

“…There were 7 studies covering 2 topics each [3,13,14,15,16,17,18] and 7 meta-analyses [19,20,21,22,23,24,25]. 20 studies (29.4%) were from Europe [3,5,9,10,11,12,15,22,26,27,28,29,30,31,32,33,34,35,36,37,38,] 20 from the US [4,14,17,19,20,24,39,40,41,42,43,44,45,46,47,48,49,50,51,52], 3 studies (4.4%) from US plus Europe [23,53,54], 6 studies (8.8%) from Japan [16,55,56,57,58,59], 6 studies (8.8%) from China [18,25,60,61,62,63], 2 studies (3.0%) from Hong Kong [13,64,65], 3 studies (4.4%) from Canada [66,67,68], 3 studies (4.4%) from India [21,69,70] and 5 studies (7.4%) from other countries [7,71,72,73,74]. 21 studies (30.9%) used the National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) scale for assessment of OM.…”

“…1 Studies on oral mucositis (OM). Incidence of OM was investigated in patients with hematopoietic stem cell transplantation (HSCT) in 14 studies (32.6%) [3,5,14,17,19,28,31,36,37,39,44,56,62,67], in head and neck cancer (HNC) patients in 13 studies (30.2%) [18,21,29,40,50,51,55,59,60,61,63,70,73], in patients with chemotherapy in 13 studies (30.2%) [15,16,22,23,24,25,30,34,38,46,48,58,71], with mixed tumor types and treatment in 1 study (2.3%) [13] and with palliative care in 2 studies (4.7%) [32,57]. Cost related to OM in patients undergoing HSCT was the focus in 4 studies [7,14,17,54], in HNC patients in 2 studies [43,47], in patients with chemotherapy in 6 studies [9,10,11,12,42,49,68], and in patients with mixed tumor types and treatment in 2 studies [20,45].…”

“…One 1 study rated with an evidence level as ‘very low' was not considered [14]. Overall, 4 studies lacked frequencies for OM of all grades [31,39,56,62], 1 study reported different frequencies for the WHO and the NCI-CTCAE scales [28] and 1 study for 2 different conditioning regimens [19]. …”

Prediction of mucositis risk secondary to cancer therapy: a systematic review of current evidence and call to action

“…Unsurprisingly, the strongest level of evidence was achieved for the volume of target organ (gastrointestinal tract and oral cavity, to lesser extent) exposed to irradiation [35,32,38,98,36,40,39,31]. Similarly, increasing doses of melphalan [23,24] and methotrexate [25], myeloablative conditioning therapy[102, 103,88] and conventional RT (vs IMRT) [45] were all robustly demonstrated to increase an individual's risk of mucositis.…”

Effects of Matricaria Recutita (L.) in the Treatment of Oral Mucositis

“…This whole range of events significantly interferes in the patient's quality of life. Furthermore, in the most severe degrees, oral mucositis may require partial or complete interruption of the antineoplastic treatment, thereby increasing the proliferation of tumor cells and hindering cancer control [ 5 , 6 ].…”