Mucositis after Allogeneic Hematopoietic Stem Cell Transplantation: A Cohort Study of Methotrexate- and Non-Methotrexate-Containing Graft-versus-Host Disease Prophylaxis Regimens

Prevention of GVHD is one of the most desirable goals of BMT in aplastic anemia (AA). We reviewed the medical records of 24 consecutive patients treated with BMT for acquired AA using two different GVHD prevention strategies. Ten patients were given alemtuzumab-based GVHD prophylaxis (50-60 mg in three divided doses on days À8, À7 and À6), and 14 patients were given conventional GVHD prophylaxis with calcineurin inhibitors plus MTX before the introduction of the alemtuzumab-based protocols. The incidence of acute, chronic and 'serious GVHD' was significantly reduced in alemtuzumab-treated patients compared to conventionally treated patients [11 vs 64% (P ¼ 0.03), 0 vs 78% (P ¼ 0.002) and 0 vs 57% (P ¼ 0.007), respectively]. Engraftment time and rates of graft failure appeared similar in the two groups. A significantly higher proportion of alemtuzumab-treated patients developed CMV reactivation compared to control patients (83 vs 12%; P ¼ 0.03); none developed CMV disease. The rates of other infectious complications did not appear significantly different. Our data suggest that 50-60 mg of alemtuzumab given according to the current schedule significantly reduces the risk of GVHD without increasing the risk of graft failure or serious infections.

Section: Discussionmentioning

confidence: 99%

Graft-versus-host disease following marrow transplantation for aplastic anemia: different impact of two GVHD prevention strategies

Siegal

Sutherland

et al. 2008

“…Nonetheless, it is well know that MTX has several potentially relevant toxicities (pulmonary, hepatic, gastrointestinal and hematopoietic toxicity). 6,7 In addition, we recently reported that MTX is a risk factor for early acute renal failure, which may contribute to early and late NRM in allo-RIC patients. 8 The higher rate of mucositis, the trend to higher rate of neutropenic fever in addition to a more frequent early non-related GVHD deaths, observed in this group of patients, may support the higher toxicity of MTX.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 However, MTX delays hematopoietic engraftment, worsens oral mucositis and may be associated with pulmonary and renal toxicity after allo-HSCT. [5][6][7][8] In patients undergoing allo-RIC, reducing procedure-related toxicities may be of great importance, as these patients usually have greater comorbidities. Thus, in an attempt to reduce any MTX-associated toxicities, mycophenolate mofetil (MMF) has replaced MTX in RIC regimens in recent years.…”

Section: Introductionmentioning

confidence: 99%

MTX or mycophenolate mofetil with CsA as GVHD prophylaxis after reduced-intensity conditioning PBSCT from HLA-identical siblings

Piñana

Valcárcel

Fernández‐Avilés

et al. 2010

Mycophenolate mofetil (MMF) in combination with CsA seems to lead to earlier post transplant hematological recovery and less mucositis than MTX, with a similar incidence of GVHD. In this study we analyzed the post transplant outcomes of two cohorts of patients who underwent an HLA-identical sibling reduced intensity conditioning transplantation (allo-RIC) with GVHD prophylaxis consisting of CsA in combination with either MMF or a short course of MTX. We included 145 consecutive allo-RIC transplants performed between April 2000 and August 2007. The median follow-up for survivors was 41 months (4-105 months). The study group included 91 males. Median age was 55 years (range 18-71 years). Diagnoses included myeloid (n ¼ 65) and lymphoid (n ¼ 80) malignancies. GVHD prophylaxis consisted of CsA/MMF in 52 and CsA/MTX in 93 patients. The conditioning regimen was based on fludarabine in combination with BU (n ¼ 59) or melphalan (n ¼ 86). The occurrence of grade 2-4 mucositis was higher in the CsA/MTX group than in the CsA/MMF group (57 vs 23%, P ¼ 0.001). The cumulative incidence of acute and chronic GVHD was similar, 48 vs 50% and 71 vs 68%, respectively (P40.7). The 2-year relapse and OS were similar in the CsA/MTX and CsA/MMF groups (29 vs 21%, P ¼ 0.3 and 52 vs 51%, P ¼ 0.7, respectively). Our results support further prospective studies comparing the use of the CsA/MMF combination with CsA/MTX as GVHD prophylaxis in HLA-identical sibling donor allo-RIC recipients.

“…One of the most common complications of this regimen is oral mucositis (OM) and literature shows that 75% of allogeneic hematopoietic SCT recipients may develop severe OM. 2 Probable consequences of OM include pain, increased risk of infection, impaired nutritional intake and prolonged hospitalization. 3 OM is characterized by mucosal damage ranging from mild inflammation to extensive ulceration.…”

Section: Introductionmentioning

confidence: 99%

N-acetyl cysteine for prevention of oral mucositis in hematopoietic SCT: a double-blind, randomized, placebo-controlled trial

Moslehi

Taghizadeh-Ghehi

Gholami

et al. 2014

Oral mucositis (OM) is a complication of high-dose chemotherapy (HDC) which is frequently observed in hematopoietic SCT settings. Antioxidant agents have been proposed to prevent OM and therefore N-acetyl cysteine (NAC) could have an important role. In the present study, we conducted a double-blind, randomized, placebo-controlled study to evaluate the NAC effect on OM incidence and severity, and also glutathione peroxidase-1 activity. Leukemia patients undergoing allogeneic hematopoietic SCT preceded by HDC were recruited into the study and received either NAC (100 mg/kg/day) (n = 38) or placebo (n = 42) from the starting day of HDC until day +15 after transplantation. OM was evaluated daily for 21 days after transplantation according to World Health Organization oral toxicity scale. The incidence of severe OM (grades 3-4) was significantly lower in the NAC group (23.7% vs 45.3%, P = 0.04). Moreover, the mean duration of OM was significantly shorter in the intervention group (6.24(2.96) vs 8.12(3.97) days, P = 0.02). The glutathione peroxidase-1 activity was also significantly higher in the NAC group seven days after transplantation (3.38(2.19) vs 2.41(1.70) ng/mL, P = 0.003). It is concluded that parenteral NAC is effective in reducing the incidence of severe cases and the total duration of OM.