Mucosal injury in patients undergoing hematopoietic progenitor cell transplantation: new approaches to prophylaxis and treatment

Abstract

Summary:Hematopoietic progenitor cell transplantation is often associated with severe mucosal toxicity. The need for parenteral analgesics and parenteral nutrition are evidence of the severity of the problem in individual patients. However, the increased risk for systemic infection related to bacteremia associated with the breakdown of mucosal barriers is a significant cause of morbidity and mortality as well. There is a multitude of grading scales, demonstrating the lack of consensus among clinicians in this area. Multiple agents have been used prophylactically and therapeutically to address mucositis. While efforts have been less successful in the past, the advent of newer agents including amifostine, keratinocyte growth factor, transforming growth factor beta and interleukin-11 provides hope that this toxicity will be significantly decreased in the near future.

Incidence and severity of oral mucositis in patients undergoing haematopoietic SCT—results of a multicentre study

“…17 Moreover, some chemotherapy used in these patients have synergic properties (for example, etoposide and thiotepa) and, when used in combination, are responsible for increasing the onset of mucositis. 18 Also regarding the development of severe mucositis, in the paediatric and adult groups, the difference was not statistically significant (P ¼ 0.0870).…”

The effect of oral management on the severity of oral mucositis during hematopoietic SCT

“…The toxicity grades for OM according to the WHO and NCI-CTC criteria are similar; the WHO criteria focus on oral intake and CTCAE focus on the ability to swallow. 14 In our study, the CTCAE were used as follows: grade 1, mild; grade 2, moderate; grade 3, severe; and grade 4, life threatening. 6 It is noteworthy that grade 0 OM was observed in 41.7% of the patients of the oral management group, but only 8.3% of those in the control group, in the present study.…”

Autotransplant conditioning regimens for aggressive lymphoma: are we on the right road?

“…Cytoprotectants such as amifostine or the endothelial growth stimulators (palifermin and velafermin) may also help reduce mucositis and gastrointestinal toxicity and decrease the potential for infections during transplant as well as alleviate or prevent patient discomfort. [60][61][62] Finally, new information on genetic disparity between patients may alter the approach we take in treating their disease. Differences in polymorphisms as noted above can affect drug efficacy and toxicity profile.…”