Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors

Riley, Philip; Glenny, Anne‐Marie; Worthington, Helen V; Littlewood, Anne; Mauleffinch, Luisa M. Fernandez; Clarkson, Jan E; McCabe, Martin G.

doi:10.1002/14651858.cd011990.pub2

Cited by 47 publications

(49 citation statements)

References 91 publications

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“…It has not been broadly adopted as a component of transplantation protocols and offers incomplete protection against mucositis. 30 In a randomized, phase III study of patients undergoing autologous HSCT, the incidence of severe OM was reduced from 98% to 63% (P = .001). 31 33,34 Whether this change is correlative or causative is an area of active investigation.…”

Section: Discussionmentioning

confidence: 99%

“…To date, the only Food and Drug Administration (FDA) approved therapy for mucositis prevention is palifermin. It has not been broadly adopted as a component of transplantation protocols and offers incomplete protection against mucositis . In a randomized, phase III study of patients undergoing autologous HSCT, the incidence of severe OM was reduced from 98% to 63% ( P = .001) .…”

Section: Discussionmentioning

confidence: 99%

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Risk factors and implications of oral mucositis in recipients of allogeneic hematopoietic stem cell transplantation

Shouval

Kouniavski

Fein

et al. 2019

European J of Haematology

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Background Oral mucositis (OM) is a common toxicity of stem cell transplantation (SCT). We sought to evaluate OM burden, risk factors, and implications in a cohort of allogeneic‐SCT recipients. Methods This was a single‐center study including 115 adult allogeneic‐SCT transplanted between 2016 and 2018 for various hematological conditions. Conditioning intensity was categorized as myeloablative (MAC, 39%), reduced intensity (34%), or reduced toxicity (RTC, 27%) in patients conditioned with fludarabine‐treosulfan. OM was prospectively graded using the Common Terminology Criteria for Adverse Events (v.4.0) system. Results Moderate‐to‐severe OM (grade 2‐4) was experienced by 60% of patients. In a univariate analysis, younger age (P = .023), lower body mass index (P = .01), recent smoking (P = .08), recent antibiotics exposure (P = .018), MAC (P < .001), and methotrexate (P = .009) were associated with moderate‐to‐severe OM. In a multivariable logistic regression model, conditioning and graft‐versus‐host disease prophylaxis remained significant. OM risk was lowest with RTC (RTC vs MAC: odd ratio [OR] 0.05, P < .001), and recent antibiotic exposure trended toward increased risk (OR 1.88, P = .168). OM was associated with longer hospitalization, delayed neutrophil engraftment, and gastrointestinal‐related infections. Conclusion Oral mucositis remains a leading SCT complication. Treosulfan‐based conditioning has low mucosal toxicity and is appealing given previous reports on its high efficacy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors and implications of oral mucositis in recipients of allogeneic hematopoietic stem cell transplantation

Shouval

Kouniavski

Fein

et al. 2019

European J of Haematology

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“…It is a health concern particularly for this population, given studies indicate children may be at higher risk for mucositis than adults. 21 An extensive database containing comprehensive studies on OM prevention among adult populations exists, [22][23][24][25][26] with interference with anticancer activity by underlying tumor type. 27 Large, well-controlled studies in pediatric patients are lacking.…”

Section: Discussionmentioning

confidence: 99%

Management of oral mucositis in pediatric patients receiving cancer therapy: A systematic review and meta‐analysis

Mazhari

Shirazi

Shabzendehdar

2018

Pediatric Blood & Cancer

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Background One of the most common complications of cancer chemotherapy is oral mucositis (OM). OM affects more than 75% of patients undergoing chemotherapy and represents a significant burden to patients and caregivers. We performed a systematic review and metaanalysis of published studies to investigate the effects of agents and techniques in reducing OM. Procedure This systematic review investigated, critically appraised, and rated the evidence on agents used to manage OM in children undergoing cancer therapy. A comprehensive search of the relevant literature was performed from January 2006 to December 2017. MEDLINE, Scopus, the Cochrane Database of Systematic Reviews, EMBASE, and the Web of Science were searched. Nine eligible studies were identified. Using randomeffects models, standardized mean difference was estimated between treated and control groups across all studies. The Cochran test and the I2 index were performed for heterogeneity between studies. The significance level was set at P = 0.05. Results Palifermin reduced the incidence (OR = 4.131, P = 0.000), duration (St diff mean = 0.803, P = 0.000), and severity (St diff mean = 0.637, P = 0.000) of OM in pediatric cancer patients significantly. However, the laser did not show significant efficacy in decreasing the incidence rate of OM (OR = 2.870, P = 0.364). Conclusion This review provided a comprehensive examination of available options for children who have OM. The results support the possibility of a positive effect of palifermin on reducing OM in children receiving cancer therapy.

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“…Accordingly, several studies have established associations between chemotherapy‐induced oral and intestinal toxicity and adverse treatment outcomes including fever, severe infections, and overall mortality . Nevertheless, options for treatment and prevention are currently limited to highly specific disease settings and, in children, to oral care protocols …”

Section: Introductionmentioning

confidence: 99%

“…7,11,16,17 Nevertheless, options for treatment and prevention are currently limited to highly specific disease settings and, in children, to oral care protocols. [18][19][20] Colostrum, the first milk produced after birth, has evolved to provide nutrition, protective, and trophic factors for the newborn mammal, contributing to the development and integrity of the gastrointestinal tract and to the immunological defense in the neonatal period. 21 It has the potential to neutralize toxins and possesses antimicrobial activity, making it a potential beneficial dietary intervention to treat or prevent chemotherapy-induced oral and intestinal toxicity.…”

Section: Introductionmentioning

confidence: 99%

Bovine Colostrum Against Chemotherapy‐Induced Gastrointestinal Toxicity in Children With Acute Lymphoblastic Leukemia: A Randomized, Double‐Blind, Placebo‐Controlled Trial

Rathe

Pietri

Wehner

et al. 2019

J Parenter Enteral Nutr

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Background The toxic effect of chemotherapy on the gastrointestinal tract may lead to mucositis and is associated with the pathogenesis of other treatment‐related complications. We hypothesized that nutrition supplementation with bovine colostrum, rich in bioactive factors, would ameliorate gastrointestinal toxicity and reduce the incidence of fever and infectious complications during induction treatment for childhood acute lymphoblastic leukemia (ALL). Methods Children with newly diagnosed ALL were included in a 2‐center, randomized, double‐blind, placebo‐controlled clinical trial. Patients were randomized to receive a daily colostrum or placebo supplement during 4 weeks of induction treatment. Data on fever, bacteremia, need for antibiotics, and mucosal toxicity were prospectively collected. (Trial registration: http://www.clinicaltrials.gov NCT01766804). Results Sixty‐two patients were included. No differences were found for the primary outcome (number of days with fever). No difference was observed for neutropenic fever, intravenous antibiotics, or incidence of bacteremia. Peak severity of oral mucositis was significantly reduced by colostrum (7/29 patients, 24% mild; 6/29, 21% moderate; 1/29, 3% severe) compared with placebo (12/31, 39% mild; 1/31, 3% moderate; 7/31, 23% severe) (P = 0.02). Among patients receiving at least 1 dose of supplement (colostrum: n = 22; placebo: n = 30), the peak weekly self‐reported oral mucositis score was overall significantly less severe in the colostrum group (P = 0.009). Conclusion The use of prophylactic bovine colostrum showed no effect on fever, infectious morbidity, or inflammatory responses. Nevertheless, these data may suggest protective effects on the oral mucosa during induction therapy in childhood ALL, encouraging additional studies confirming these findings.

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Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors

Cited by 47 publications

References 91 publications

Risk factors and implications of oral mucositis in recipients of allogeneic hematopoietic stem cell transplantation

Risk factors and implications of oral mucositis in recipients of allogeneic hematopoietic stem cell transplantation

Management of oral mucositis in pediatric patients receiving cancer therapy: A systematic review and meta‐analysis

Bovine Colostrum Against Chemotherapy‐Induced Gastrointestinal Toxicity in Children With Acute Lymphoblastic Leukemia: A Randomized, Double‐Blind, Placebo‐Controlled Trial

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