Icing oral mucositis: Oral cryotherapy in multiple myeloma patients undergoing autologous hematopoietic stem cell transplant

Abstract

Background Up to 70% of patients receiving hematopoietic stem cell transplant develop oral mucositis as a side effect of high-dose melphalan conditioning chemotherapy. Oral cryotherapy has been documented to be potentially effective in reducing oral mucositis. The aim of this study was to examine the effectiveness of the cryotherapy protocol implemented within the hematopoietic stem cell transplant program. Methods A retrospective chart review was conducted of adult multiple myeloma patients who received high-dose melphalan conditioning therapy for autologous hematopoietic stem cell transplant. Primary endpoints were incidence and severity of oral mucositis. Secondary endpoints included duration of oral mucositis, duration of hospital stay, parenteral narcotics use and total parenteral nutrition use. Results One hundred and forty patients were included in the study, 70 patients in both no cryotherapy and cryotherapy groups. Both oral mucositis incidence and severity were found to be significantly lower in the cryotherapy group. Fifty (71.4%) experienced mucositis post cryotherapy compared to 67 (95.7%) in the no cryotherapy group (p < 0.001). The median oral mucositis severity, assessed using the WHO oral toxicity scale from grade 0-4, experienced in the no group was 2.5 vs. 2 in the cryotherapy group (p = 0.03). Oral mucositis duration and use of parenteral narcotics were also significantly reduced. Duration of hospital stay and use of parenteral nutrition were similar between the two groups. Conclusion The cryotherapy protocol resulted in a significantly lower incidence and severity of oral mucositis. These results provide evidence for the continued use of oral cryotherapy, an inexpensive and generally well-tolerated practice.

Nutritional interventions for oral mucositis: a systematic literature review

“…Of the 915 articles, 893 were potentially eligible for inclusion and 802 were then excluded based on title and abstract. After full texts were obtained and eligibility criteria applied to the remaining 91 articles, 23 articles 23,24,28‐49 were included in the review (total unique study participants n = 7605; Table 1). These included five systematic reviews with meta‐analyses 23,41,43‐45 ; six systematic reviews, 24,34,35,38,39,46 two randomised controlled trials (RCTs) 30,33 ; one non‐randomised controlled trial 48 ; four prospective cohort studies 32,37,42,47 ; two retrospective cohort studies 29,31 and three case series 28,36,40 …”

“…Articles investigating more than one intervention were eligible to fall into multiple intervention review areas. These included: oral cryotherapy (five studies; n = 1777) 29,30,39,41,44 ; elemental oral nutrition supplements (five studies; n = 186) 31,32,36,37,42 ; beta‐hydroxy‐beta‐methylbutyrate‐, arginine‐ and glutamine‐enriched (HMB/Arg/Gln) powdered supplement (two studies; n = 64) 47,48 ; immune‐modulating oral nutrition supplements (one study; n = 40) 28 ; fat‐soluble vitamins (two studies; n = 103) 23,46 ; glutamine supplementation (five studies; n = 2050) 24,33,38,40,46 ; zinc supplementation (three studies; n = 1009) 34,43,46 ; miscellaneous mineral supplements (two studies; n = 1188) 34,46 and honey (three studies; n = 1292) 35,45,46 …”

Effect of cryotherapy in preventing mucositis associated with the use of 5-fluorouracil

“…A larger number of studies using cryotherapy in a population of patients with onco-hematological disease was identified than in solid tumors, as in the present study. Onco-hematological patients can be subjected to induction for hematopoietic stem cell transplantation with another drug, melphalan, also a potential etiologic factor for mucositis (7,(19)(20)(21) .…”

Assessment of oral mucositis degree due to cytostatic treatment in patients with malignant lymphomas

“…Oral cryotherapy is effective for the prevention of oral mucositis in adults receiving fluorouracil-based chemotherapy for solid cancers, and for the prevention of severe oral mucositis in adults receiving high-dose melphalan-based chemotherapy [15,16] Other studies: Welbury R and Murray J. show that oral lesions occur mainly in patients with poor oral hygiene and periodontal disorders [17].…”