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Nosek K, Leppert W, Puchała Ł, Łoń K. Efficacy and Safety of Topical Morphine: A Narrative Review. Pharmaceutics 2022; 14:pharmaceutics14071499. [PMID: 35890392 PMCID: PMC9324750 DOI: 10.3390/pharmaceutics14071499] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background. Opioids are the cornerstone of the therapy used in both acute and chronic pain syndromes to treat pain of moderate to severe intensity. The knowledge that opioid receptors also occur in other tissues outside the central nervous system has created a possibility for the topical use of opioids. Thus, local analgesia may be obtained without systemic adverse effects. Methods. A narrative review of scientific papers discussing the topical use of morphine was conducted. For this purpose, the PubMed, Google Scholar, Cochrane Library, and Mendeley databases were searched. Results. The current knowledge on topical morphine does not allow for its recommended use in everyday medical practice, but suggests it may be effective, particularly in the treatment of ulcers and erosions of inflammatory etiology and painful skin lesions including persistent post-mastectomy pain due to breast cancer. Conclusions. Topical morphine has its place beside other analgesics. An important issue is the practical possibility to meet the demand for topical formulations, which is limited by technical difficulties.
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Affiliation(s)
- Krzysztof Nosek
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Warmia and Mazury, 10-719 Olsztyn, Poland; (K.N.); (Ł.P.); (K.Ł.)
| | - Wojciech Leppert
- Chair of Palliative Medicine, Institute of Medical Sciences, Collegium Medicum, University of Zielona Góra, 65-417 Zielona Góra, Poland
- University Hospital of Heliodor Święcicki, Poznań University of Medical Sciences, 61-245 Poznań, Poland
- Correspondence:
| | - Łukasz Puchała
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Warmia and Mazury, 10-719 Olsztyn, Poland; (K.N.); (Ł.P.); (K.Ł.)
| | - Krzysztof Łoń
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Warmia and Mazury, 10-719 Olsztyn, Poland; (K.N.); (Ł.P.); (K.Ł.)
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Hari P, Chhabra S. A Review of Propylene Glycol-free Melphalan Conditioning for Hematopoietic Cell Transplantation for Multiple Myeloma and Light Chain Amyloidosis. Transplant Cell Ther 2022; 28:242-247. [PMID: 35196581 DOI: 10.1016/j.jtct.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/04/2022] [Accepted: 02/12/2022] [Indexed: 01/05/2023]
Abstract
Autologous hematopoietic cell transplantation (AHCT) remains a standard therapeutic option for patients with multiple myeloma (MM). Outcomes have improved for this patient group after first AHCT, with the use of novel agents in induction, as well as post-transplantation maintenance. High-dose melphalan remains the gold standard as the conditioning regimen for MM. Traditional melphalan is a lyophilized formulation that after reconstitution has insufficient chemical stability and water solubility, thus requiring the addition of propylene glycol to act as a cosolvent to improve these characteristics. After the reconstitution of melphalan with propylene glycol-containing solution, impurities can develop within 30 minutes, and if further dilution occurs, the potency of melphalan diminishes. Propylene glycol is associated with a spectrum of toxicities that can be dose limiting. Evomela is a propylene glycol-free melphalan (PGF-Mel) that at a high dose of 200 mg/2 (100 mg/m2/d for 2 days) is approved for conditioning before AHCT in MM patients. Once reconstituted by directly dissolving in saline solution, PGF-Mel solution can be stored in the vial for up to 1 hour at room temperature or for up to 24 hours at refrigerated temperature (2° to 8°C) with no significant degradation. The demonstrated stability, up to 24 hours at room temperature, results in reduced handling requirements and increased convenience and flexibility of administration. Since its approval, Evomela has been the subject of several retrospective and investigator-initiated studies. This review summarizes the prospective and real-world evidence on practical aspects of PGF-Mel and critically appraises the available data and its clinical implications.
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Affiliation(s)
- Parameswaran Hari
- Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saurabh Chhabra
- Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Maruoka Y, Michiwaki Y, Sekiya H, Kurasawa Y, Natsume N. What does oral care mean to society? Biosci Trends 2022; 16:7-19. [DOI: 10.5582/bst.2022.01046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yutaka Maruoka
- Oral and Maxillofacial Surgery, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukihiro Michiwaki
- Division of Special Dentistry and Oral Surgery, Japanese Red Cross Musashino Hospital, Musashino, Japan
| | - Hideki Sekiya
- Department of Oral Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - Yasuhiro Kurasawa
- Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nagato Natsume
- Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
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Saber W, Steinert P, Zhang MJ, Chen M, Pope A, Keating A, Wingard JR, Ballen K, Stiff P, Perales MA, Forman S, Champlin R, Langston A, Rudebeck M, Horowitz M. A Prospective Cohort Study Comparing Long-Term Outcomes with and without Palifermin in Patients Receiving Hematopoietic Cell Transplantation for Hematologic Malignancies. Transplant Cell Ther 2021; 27:837.e1-837.e10. [PMID: 34224914 DOI: 10.1016/j.jtct.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Abstract
The incidence of debilitating oral mucositis (OM) can be as high as 99% after myeloablative conditioning regimens preparing patients with hematologic malignancies for hematopoietic cell transplantation (HCT). Palifermin (KGF) is a recombinant human keratinocyte growth factor that reduces the incidence and duration of severe OM. The long-term safety of KGF has not been well established, however. In this long-term prospective matched-cohort study, patients who received KGF (cases) and underwent autologous or allogeneic HCT for hematologic malignancies between 2006 and 2013 were matched 1:1 to patients who did not receive KGF (controls). The primary outcome was overall survival (OS). Other outcomes were disease relapse, new malignancies, pancreatitis, renal failure requiring dialysis, pulmonary complications, cataract surgery, and acute and chronic graft-versus-host disease (GVHD). The analysis population comprised 2191 matched pairs with a wide range of diseases and donor types that received diverse conditioning and GVHD preventive regimens, representing contemporary practice patterns. The median duration of follow-up was 8 years (range, 1 to 12.5 years). In multivariate analyses, the probabilities of OS (relative risk [RR], 1.01; 95% confidence interval [CI], 0.91 to 1.12), relapse (RR, 1.06; 95% CI, 0.94 to 1.18), new malignancies (RR, 0.89; 95% CI, 0.67 to 1.18), and cataract surgery (RR, 1.05; 95% CI, 0.74 to 1.50) were not statistically significantly different between cases and controls. In univariate analyses, no increased risks were observed for renal failure requiring dialysis, pancreatitis, acute GVHD, chronic GVHD, interstitial pneumonitis/acute respiratory distress syndrome/idiopathic pneumonia syndrome, or bronchiolitis obliterans/cryptogenic organizing pneumonia/bronchiolitis obliterans organizing pneumonia among cases compared with controls. This long-term prospective safety cohort study demonstrates that the KGF group had no increased risk of overall mortality, relapse, new malignancies, or any other key outcome. The broad inclusion criteria allow the results to be generalized to contemporary practice for patients with a wide range of diseases and receiving a wide range of HCT conditioning regimens and graft sources from diverse donor types.
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Affiliation(s)
- Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Patricia Steinert
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Min Chen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrea Pope
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Armand Keating
- Princess Margaret Cancer Center-BMT Program, Toronto, Ontario, Canada
| | - John R Wingard
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida
| | - Karen Ballen
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia
| | - Patrick Stiff
- Division of Hematology/Oncology, Loyola University Medical Center, Maywood, Illinois
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen Forman
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Richard Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amelia Langston
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | - Mary Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Zigmundo GCDO, Schmidt TR, Silveira FM, Neves M, Martins MAT, Carrard VC, Martins MD. Analysis of referrals to the stomatology service in a Southern Brazilian hospital: a retrospective study. Braz Oral Res 2021; 35:e072. [PMID: 34161411 DOI: 10.1590/1807-3107bor-2021.vol35.0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/22/2020] [Indexed: 01/24/2023] Open
Abstract
This paper intends to describe the demand for referrals to the stomatology service requested by the medical teams for inpatients in a reference hospital in the south of Brazil. This research is a retrospective cross-sectional descriptive study focusing on data collection and assessment of information about referrals to the stomatology unit carried out from January 2008 to December 2018. All information was obtained from the hospital management software database, then transferred and analyzed individually for descriptive statistics. A total of 4433 cases were referred to the stomatology team, with an average of 403 cases by year. Hematology/hemato-oncology (37.3%) was the specialty asking for the majority of the referrals, followed by Oncology (20.4%) and Pneumology (8.2%). The mean patients' profile was males (55.5%), receiving a diagnosis of oral mucositis (43.5%), and with the first and second decades of life being the most prevalent ones (34.9%), with a mean age of 34.8±22.3 years. The most common treatment performed by the stomatology team was the photobiomodulation therapy (44.8%). This retrospective study demonstrated the important profile of the stomatological care in hospitalized patients from a specific hospital, especially referred by the hematology/hemato-oncology team. These results evidenced the importance of the stomatology specialty in the hospital environment.
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Affiliation(s)
| | - Tuany Rafaeli Schmidt
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Felipe Martins Silveira
- Universidade Estadual de Campinas, Piracicaba Dental School, Department of Oral Diagnosis, Piracicaba, SP, Brazil
| | - Matheus Neves
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Preventive Dentistry, Porto Alegre, RS, Brazil
| | | | - Vinicius Coelho Carrard
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
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Mawardi H, Treister N, Felemban O, Alamoudi W, Algohary G, Alsultan A, Alshehri N, Tazi I, Shaheen M, Alsharani M, Alshemmari S, Arat M, Bekadja MA, Al-Khabori M, Okaily S, Ali N, Abujazar H, Jastaniah W, Hamidieh AA, Hashmi S, Aljurf M. Current practice of oral care for hematopoietic stem cell transplant patients: A survey of the Eastern Mediterranean Blood and Marrow transplantation group. Hematol Oncol Stem Cell Ther 2021; 16:42-51. [PMID: 36634283 DOI: 10.1016/j.hemonc.2021.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION The oral cavity is one of the most common sites impacted by hematopoietic stem cell transplantation (HSCT) with acute complications including mucositis, bleeding, salivary gland dysfunction, infection, and taste alteration. These complications may result in significant morbidity and can negatively impact outcomes such as length of stay and overall costs. As such, oral care during HSCT for prevention and management of oral toxicities is a standard component of transplant protocols at all centers. The objective of this study was to evaluate the current oral care practices for patients during HSCT at different transplant centers within the Eastern Mediterranean region. MATERIAL AND METHODS An internet-based survey was directed to 30 transplant centers in the Eastern Mediterranean region. The survey included five sections asking questions related to (1) transplant center demographics; (2) current oral care protocol used at the center and type of collaboration (if any) with a dental service; (3) use of standardized oral assessment tools and grading systems for mucositis; (4) consultations for management of oral complications; and (5) oral health needs at each center. Data are presented as averages and percentages. RESULTS A total of 16 responses from 11 countries were collected and analyzed, indicating a response rate of 53%. Eight centers reported that a dentist was part of the HSCT team, with four reporting oral medicine specialists specifically being part of the team. Almost all centers (15/16; 93%) had an affiliated dental service to facilitate pre-HSCT dental clearance with an established dental clearance protocol at 14 centers (87%). Dental extraction was associated with the highest concern for bleeding and the need for platelet transfusion. With respect to infection risk, antibiotic prophylaxis was considered in the setting of low neutrophil counts with restorative dentistry and extraction. All centers provide daily reinforcement of oral hygiene regimen. The most frequently used mouth oral rinses included sodium bicarbonate (68%) and chlorhexidine gluconate (62%), in addition to ice chips for dry mouth (62%). The most frequently used mucositis assessment tools were the World Health Organization scale (7/16; 43%) and visual analogue scale for pain (6/16; 37%). Mucositis pain was managed with lidocaine solution (68.8%), magic mouth wash (68.8%) and/or systemic pain medications (75%). CONCLUSIONS Scope and implementation of oral care protocols prior to and during HSCT varied between transplant centers. The lack of a universal protocol may contribute to gaps in oral healthcare needs and management for this group of patients. Further dissemination of and education around available oral care guidelines is warranted. CLINICAL RELEVANCE Considering oral care during HSCT a standard component of transplant protocols, the current study highlights the common oral care practices for patients at centers within the Eastern Mediterranean region.
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Affiliation(s)
- Hani Mawardi
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Osama Felemban
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Waleed Alamoudi
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | | | - Illias Tazi
- Department, CHU Mohamed VI, Cadi Ayyad University, Marrakech, Morocco
| | - Marwan Shaheen
- Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | - Mutlu Arat
- Florence Nightingale Hospital, HSCT Unit, Istanbul, Turkey
| | | | - Murtadha Al-Khabori
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | | | | | | | - Amir Ali Hamidieh
- Pediatric Cell Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharukh Hashmi
- Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Oh HJ, Hong SY, Jeong YM, Choi KS, Lee E, Lee E, Kim YJ, Bang SM. Drug use evaluation of opioid analgesics in pain management among patients with hematopoietic stem cell transplantation. Blood Res 2020; 55:151-158. [PMID: 32883891 PMCID: PMC7536558 DOI: 10.5045/br.2020.2020056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/15/2020] [Accepted: 08/07/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) patients usually experience mucositis, musculoskeletal pain associated with high-dose chemotherapy, radiation, post-HSCT infection, or graft-versus-host disease. Pain management is important for the patients' quality of life. We evaluated appropriate opioid analgesic use in HSCT patients to propose effective pain management strategies. METHODS A retrospective analysis was conducted using electronic medical records of adult patients with HSCT treated with opioids for moderate to severe pain at Seoul National University Bundang Hospital. The numeric rating scale (NRS) was used in pain management. NRS scores of 4‒10 correspond to moderate to severe pain. Appropriate opioid analgesic use was evaluated following published cancer pain management guidelines. RESULTS In total, 119 cases were evaluated, including 369 episodes of moderate to severe pain. Mucositis-related, musculoskeletal, and headache pain occurred in 62.6%, 25.8%, and 6.0% of episodes, respectively. Frequently used opioids were intravenous tramadol (84.9%), fentanyl patch (73.9%), and intravenous morphine sulfate (68.9%). Intravenous and topical administrations were used for mucosal pain. In total, 95.0% of patients received appropriate short-acting opioids for initial pain management, 80.5% received appropriate doses of short-acting opioids, appropriate opioids dose adjustment was done after first assessment in 95.5% of patients, and 85.6% were converted to appropriate long-acting opioids. CONCLUSION Short-acting opioid analgesic use for initial pain management and dose adjustment after assessment were appropriate. However, initial and conversion dosages recommended by guidelines may be difficult to implement considering the severity of HSCT patients. Pain management guidelines specific for HSCT patients should be developed in the future.
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Affiliation(s)
- Hyun Jin Oh
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So Yeon Hong
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Mi Jeong
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Suk Choi
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunsook Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Euni Lee
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soo-Mee Bang
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Takahashi M, Toyosaki M, Matsui K, Machida S, Kikkawa E, Ota Y, Kaneko A, Ogawa Y, Ando K, Onizuka M. An analysis of oral microbial flora by T-RFLP in patients undergoing hematopoietic stem cell transplantation. Int J Hematol 2020; 112:690-696. [PMID: 32770478 DOI: 10.1007/s12185-020-02958-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022]
Abstract
Even though the hematopoietic stem cell transplantation (HSCT) procedure has been improved, oral mucositis (OM) is still a severe complication of the conditioning regimen. We investigated the association between OM severity and the alteration of oral bacterial flora using 16S rRNA gene-based terminal restriction fragment length polymorphism (T-RFLP) analysis in 19 consecutive patients undergoing HSCT. Oral samples were collected at pre-transplantation, at the peak of mucositis and post-engraftment. T-RFLP profiles for each timepoint were constructed into an X-Y matrix, and the distances between timepoints were calculated. Patients with severe and moderate OM had larger changes in their oral bacterial flora from before HSCT to peak of mucositis than controls (p = 0.031 and 0.016, respectively). Moreover, severe mucositis was significantly associated with an extended period of fever until engraftment, high maximum C-reactive protein levels, and prolonged periods of opioid treatment and intravenous hyper-alimentation. These findings suggest that mucositis severity is associated with the magnitude of change in the oral bacterial flora. This novel finding may help advance strategies for the prevention or treatment of OM after HSCT.
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Affiliation(s)
- Miho Takahashi
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masako Toyosaki
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Keiko Matsui
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Shinichiro Machida
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Eri Kikkawa
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yoshihide Ota
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Akihiro Kaneko
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yoshiaki Ogawa
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kiyoshi Ando
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
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Wilairat P, Kengkla K, Kaewpanan T, Kaewthong J, Ruankon S, Subthaweesin C, Stenehjem DD, Saokaew S. Comparative efficacy and safety of interventions for preventing chemotherapy-induced oral mucositis in adult cancer patients: a systematic review and network meta-analysis. Eur J Hosp Pharm 2020; 27:103-110. [PMID: 32133137 PMCID: PMC7043259 DOI: 10.1136/ejhpharm-2018-001649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/03/2018] [Accepted: 10/09/2018] [Indexed: 01/15/2023] Open
Abstract
Objective To examine the comparative efficacy and safety of interventions for preventing chemotherapy-induced oral mucositis (OM) in adult cancer patients. Methods We searched PubMed, Embase and the Cochrane Central systematically for the randomised control trials (RCTs) of interventions for preventing OM. Network meta-analysis (NMA) was performed to estimate risk ratios (RR) and 95% confidence intervals (CI) from both direct and indirect evidence. The primary outcome was any grade of OM. Secondary outcomes were mild-moderate OM, severe OM and adverse events, such as taste disturbance and gastrointestinal adverse events. This study was registered with PROSPERO, number CRD42016052489. Results A total of 29 RCTs with 2348 patients (median age, 56.1 years; 57.5% male) were included. Cryotherapy was associated with a significantly lower risk of OM than control (RR 0.51, 95% CI 0.38 to 0.68), and zinc sulphate (RR 0.47, 95% CI 0.23 to 0.97), but not significantly lower than sucralfate and palifermin. No significant differences were observed between cryotherapy and control for taste disturbance and gastrointestinal adverse events. Palifermin was associated with the highest risk of taste disturbance. Conclusions This NMA suggests that cryotherapy was the most effective intervention for preventing chemotherapy-induced OM with a safety profile similar to control, but not significantly lower than sucralfate and palifermin. Large RCTs are needed to confirm these findings.
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Affiliation(s)
- Preyanate Wilairat
- School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Centre of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Kirati Kengkla
- School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Centre of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | | | - Jirapat Kaewthong
- School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Sorave Ruankon
- School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | | | - David D Stenehjem
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, Minnesota, USA
| | - Surasak Saokaew
- School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Centre of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Centre of Pharmaceutical Outcomes Research (CPOR), Naresuan University, Phitsanulok, Thailand
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Global Evidence Synthesis Initiative (GESI) Network, Subang Jaya, Malaysia
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Luo J, Bian L, Blevins MA, Wang D, Liang C, Du D, Wu F, Holwerda B, Zhao R, Raben D, Zhou H, Young CD, Wang XJ. Smad7 Promotes Healing of Radiotherapy-Induced Oral Mucositis without Compromising Oral Cancer Therapy in a Xenograft Mouse Model. Clin Cancer Res 2019; 25:808-818. [PMID: 30185419 PMCID: PMC6335168 DOI: 10.1158/1078-0432.ccr-18-1081] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/02/2018] [Accepted: 08/31/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE We previously reported preventive and therapeutic effects of Smad7, a multifunctional protein, on radiotherapy (RT)-induced mucositis in mice without promoting human oral cancer cell survival or migration in vitro. The current study aims to determine whether a Smad7-based biologic can treat existing oral mucositis during radiotherapy for oral cancer and whether this treatment compromises RT-induced cancer cell killing in neighboring oral cancer.Experimental Design: We transplanted human oral cancer cells into the tongues of mice and applied craniofacial irradiation to simultaneously kill tumor cells and induce oral mucositis, thus modeling RT and mucositis in oral cancer patients. We topically applied a recombinant human Smad7 protein fused with the cell-penetrating Tat tag (Tat-Smad7) to the oral mucosa of tumor-bearing mice post RT when oral mucositis began to develop. RESULTS Topically applied Tat-Smad7 penetrated cells in both the oral mucosa and oral cancer, attenuating TGFβ and NF-κB signaling as well as inflammation at both sites. Tat-Smad7 treatment alleviated oral mucositis with reductions in DNA damage and apoptosis in keratinocytes, but increased keratinocyte proliferation compared with vehicle-treated mucositis lesions. In contrast, adjacent oral cancer exposed to Tat-Smad7 did not show alterations in proliferation or direct DNA damage, but showed increased oxidative stress damage and apoptosis compared with tumors treated with vehicle. CONCLUSIONS Our results suggest that short-course Tat-Smad7 application to oral mucositis promotes its healing but does not compromise the cytotoxic effect of RT on oral cancer and has context-specific effects on oral mucosa versus oral cancer.
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Affiliation(s)
- Jingjing Luo
- State Key Laboratory of Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P.R. China
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Li Bian
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Pathology, the First Affiliated Hospital of Kunming Medical University, Kunming, P.R. China
- Allander Biotechnologies, LLC, Aurora, Colorado
| | - Melanie A Blevins
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Dongyan Wang
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Allander Biotechnologies, LLC, Aurora, Colorado
| | - Chao Liang
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Danfeng Du
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Fanglong Wu
- State Key Laboratory of Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P.R. China
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Rui Zhao
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Hongmei Zhou
- State Key Laboratory of Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P.R. China.
| | - Christian D Young
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
- Allander Biotechnologies, LLC, Aurora, Colorado
| | - Xiao-Jing Wang
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
- Allander Biotechnologies, LLC, Aurora, Colorado
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11
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Miller KC, Gertz MA, Buadi FK, Hayman SR, Wolf RC, Lacy MQ, Dispenzieri AA, Dingli D, Kapoor P, Gonsalves WI, Kourelis T, Hogan WJ, Kumar SK. Comparable outcomes using propylene glycol-free melphalan for autologous stem cell transplantation in multiple myeloma. Bone Marrow Transplant 2018; 54:587-594. [PMID: 30116014 PMCID: PMC6377862 DOI: 10.1038/s41409-018-0302-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/13/2018] [Accepted: 07/23/2018] [Indexed: 12/22/2022]
Abstract
Autologous stem cell transplantation (ASCT) remains a mainstay in the treatment of multiple myeloma (MM). While the procedure is generally safe, toxicities associated with high-dose melphalan conditioning are common and significantly affect patient quality of life. Recently, a propylene glycol-free melphalan formulation (PG-free MEL; Evomela®) was approved by the United States Food and Drug Administration as an ASCT conditioning regimen for MM. PG-free MEL is more soluble and stable than propylene glycol-solubilized melphalan (PG-solubilized MEL; Alkeran®). As such, there is speculation that it could decrease toxicities and increase the efficacy of ASCT. We compared the outcomes of patients conditioned with PG-free MEL (n=216) to PG-solubilized MEL (n=200) at our institution. The baseline characteristics were similar between the two groups. After Day +0, there were no differences in terms of hospitalizations, neutropenic fevers, intravenous granisetron requirement, World Health Organization grade ≥2 oral/esophageal mucositis, intravenous fluid requirement, or narcotic requirement. However, PG-free MEL patients had a higher incidence of diarrhea, which was mostly C. difficile-negative (82% vs. 71%, P=0.015*). Day +100 hematologic responses and progression-free survival after ASCT were comparable. In summary, we demonstrate that switching to PG-free MEL did not significantly reduce short-term complications of ASCT or improve outcomes in MM.
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Affiliation(s)
| | - Morie A Gertz
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Francis K Buadi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Suzanne R Hayman
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Robert C Wolf
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Prashant Kapoor
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wilson I Gonsalves
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - William J Hogan
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shaji K Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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12
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Efficacy of palifermin on oral mucositis and acute GVHD after hematopoietic stem cell transplantation (HSCT) in hematology malignancy patients: a meta-analysis of trials. Contemp Oncol (Pozn) 2017; 21:299-305. [PMID: 29416437 PMCID: PMC5798422 DOI: 10.5114/wo.2017.72400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/27/2017] [Indexed: 11/24/2022] Open
Abstract
Aim of the study Herein, this meta-analysis study evaluated the efficacy of palifermin after HSCT on the incidence and severity of OM or aGVHD in hematologic malignancy patients in randomized clinical trials (RCTs). Materials and methods To compare the efficacy of palifermin on adverse events, OM and aGVHD compared with placebo, we searched databases of PubMed/Medline, Web of Science and Cochrane Library for RCTs based on a number of criteria. Results There was no difference observed in the incidence of OM and aGVHD between two groups. The subgroup analysis didn’t show significant differences in two groups for aGVHD grade 2–4 (odds ratio [OR] = 1.54, 95% confidence interval (CI): 0.70–3.39, p = 0.28), aGVHD grade 3–4 (OR = 0.97, 95% CI: 0.48–1.94, p = 0.92), OM grade 2–4 (OR = 0.76, 95% CI: 0.42–1.38, p = 0.37) and OM grade 3–4 (OR = 0.54, 95% CI: 0.25–1.15, p = 0.11], but erythema as an adverse effect in palifermin group was higher than placebo group (OR = 1.86, 95% CI: 1.10–3.15, p = 0.02]. Conclusions This meta-analysis of six clinical trials found no statistically significant difference in OM and aGVHD grades in patients receiving 60 μg/kg/day dose of palifermin compared with those receiving a placebo. However, oral mucosal erythema was more prevalent among patients receiving palifermin than patients receiving a placebo.
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13
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Lipkin AC, Lenssen P, Dickson BJ. Nutrition Issues in Hematopoietic Stem Cell Transplantation: State of the Art. Nutr Clin Pract 2017; 20:423-39. [PMID: 16207682 DOI: 10.1177/0115426505020004423] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
There have been many changes in hematopoietic stem cell transplantation (HSCT) that affect the patient's nutrition support. In the early 1970s, allogeneic transplants were the most common types of HSCTs; today, autologous transplants are the most common. Bone marrow, peripheral blood, and umbilical cord blood all now serve as sources of stem cells. Conditioning therapies include myeloablative, reduced-intensity myeloablative, and nonmyeloablative regimens. New medications are being developed and used to minimize the toxicities of the conditioning therapy and to minimize infectious complications. Supportive therapies for renal and liver complications have changed. In the past, HSCT patients received parenteral nutrition (PN) throughout their hospitalization and sometimes as home therapy. Because of medical complications and cost issues associated with PN, many centers are now working to use less PN and increase use of enteral nutrition. The immunosuppressed diet has changed from a sterile diet prepared under laminar-flow hoods to a more liberal diet that avoids high-risk foods and emphasizes safety in food handling practices. This article will review these changes in HSCT and the impact of these changes on the nutrition support of the patient.
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Affiliation(s)
- Ann Connell Lipkin
- Children's Hospital and Regional Medical Center, Seattle, Washington 98105-0371, USA.
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McDonnell AM, Lenz KL. Palifermin: Role in the Prevention of Chemotherapy- and Radiation-Induced Mucositis. Ann Pharmacother 2016; 41:86-94. [PMID: 17190850 DOI: 10.1345/aph.1g473] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To assess the efficacy, toxicity, and potential cost benefit of palifermin in the prevention of chemotherapy- and radiation-induced mucositis. Data Sources: MEDLINE and PubMed database searches were conducted (1966–May 2006) using the following search terms: palifermin, human keratinocyte growth factor, fibroblast growth factor, mucositis, and stomatitis. Study Selection And Data Extraction: All published clinical trials and abstracts examining the use of palifermin, as well as information from the manufacturer, were included. Data Synthesis: Severe mucositis resulting from anticancer therapies increases healthcare expenditures and negalively impacts patients' quality-of-life. Radiation therapy to the head and neck, as well as stem cell transplant conditioning regimens, have the highest incidence of severe mucositis. Consequences include prolonged hospitalization, need for parenteral nutrition, increased risk of infection, and severe pain. Palifermin is a recombinant human keratinacyte growth factor indicated in patients with hematologic malignancies who are undergoing stem cell transplant. In a randomized, placebo-controlled, Phase III trial, palifermin significantly reduced the incidence and duration of severe mucositis and days of parenteral nutrition and opioid analgesics in patients undergoing autologous stem cell transplant. The most common adverse effects of palifermin were rash, pruritus, cough, and taste alterations. Data in patients with solid tumors are limited, and there is a theoretical risk of stimulating tumor growth. Conclusions: Treatment with palifermin appears to decrease the severity and duration of severe mucositis following autologous stem cell transplant. Use in these patients appears justified: however, use in non-stem cell transplant patients should bo discouraged until more efficacy and toxicity data are available.
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15
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Espinoza M, Perelli J, Olmos R, Bertin P, Jara V, Ramírez P. Nutritional assessment as predictor of complications after hematopoietic stem cell transplantation. Rev Bras Hematol Hemoter 2015; 38:7-14. [PMID: 26969769 PMCID: PMC4786753 DOI: 10.1016/j.bjhh.2015.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/31/2015] [Accepted: 10/13/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction Nutritional support is pivotal in patients submitted to hematopoietic stem cell transplantation. Nutritional status has been associated with time of engraftment and infection rates. In order to evaluate the association between nutritional parameters and clinical outcomes after transplantation a cohort of transplant patients was retrospectively evaluated. Methods All 50 patients transplanted between 2011 and 2014 were included. The nutritional status before transplantation, ten days after transplantation and before discharge was assessed including anthropometry, body mass index, albumin, prealbumin and total urinary nitrogen. Results The median follow-up time was 41 months and the median age of patients was 41 years. Thirty-two underwent allogeneic and 18 autologous transplants. Diagnoses included acute leukemias (n = 27), lymphoma (n = 7), multiple myeloma (n = 13), and aplastic anemia (n = 3). Thirty-seven patients developed mucositis (three Grade 1, 15 Grade 2, 18 Grade 3 and one Grade 4), and twenty-two allogeneic, and five autologous transplant patients required total parenteral nutrition. Albumin and total urinary nitrogen were associated with length of hospital stay and platelet and neutrophil engraftment. None of the nutritional parameters evaluated were associated with overall survival. Non-relapse mortality was 14% and overall survival was 79% at 41 months of follow-up. Conclusions After hematopoietic stem cell transplantation, high catabolism was associated with longer length of hospital stay, the need of total parenteral nutrition and platelet and neutrophil engraftment times. Nutritional parameters were not associated with overall survival.
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Affiliation(s)
- Marcela Espinoza
- School of Medicine, Pontificia Universidad Católica de Chile (UC), Santiago, Chile
| | - Javiera Perelli
- School of Medicine, Pontificia Universidad Católica de Chile (UC), Santiago, Chile
| | - Roberto Olmos
- School of Medicine, Pontificia Universidad Católica de Chile (UC), Santiago, Chile
| | - Pablo Bertin
- School of Medicine, Pontificia Universidad Católica de Chile (UC), Santiago, Chile
| | - Verónica Jara
- School of Medicine, Pontificia Universidad Católica de Chile (UC), Santiago, Chile
| | - Pablo Ramírez
- School of Medicine, Pontificia Universidad Católica de Chile (UC), Santiago, Chile.
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16
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Silva LC, Sacono NT, Freire MDCM, Costa LR, Batista AC, Silva GBL. The Impact of Low-Level Laser Therapy on Oral Mucositis and Quality of Life in Patients Undergoing Hematopoietic Stem Cell Transplantation Using the Oral Health Impact Profile and the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation Questionnaires. Photomed Laser Surg 2015; 33:357-63. [DOI: 10.1089/pho.2015.3911] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Nancy Tomoko Sacono
- Department of Stomatology, Faculty of Dentistry, Federal University of Goiás, Goiás, Brazil
| | | | - Luciane Rezende Costa
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Goiás, Goiás, Brazil
| | - Aline Carvalho Batista
- Department of Stomatology, Faculty of Dentistry, Federal University of Goiás, Goiás, Brazil
| | - Geisa Badauy Lauria Silva
- Hematopoietic Stem Cell Transplant Unit, Araújo Jorge Hospital, Associação de Combate ao Câncer de Goiás, Goiânia, Goiás, Brazil
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Sarvizadeh M, Hemati S, Meidani M, Ashouri M, Roayaei M, Shahsanai A. Morphine mouthwash for the management of oral mucositis in patients with head and neck cancer. Adv Biomed Res 2015; 4:44. [PMID: 25789270 PMCID: PMC4358035 DOI: 10.4103/2277-9175.151254] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 02/26/2013] [Indexed: 11/06/2022] Open
Abstract
Background: Oral mucositis is a debilitating side effect of cancer treatment for which there is not much successful treatments at yet. We evaluated the effectiveness of topical morphine compared with a routine mouthwash in managing cancer treatment-induced mucositis. Materials and Methods: Thirty head and neck cancer patients with severe mucositis (World Health Organization Grade III or IV) were randomized into the morphine and magic mouthwash groups. Patients received morphine sulfate 2% or magic solution (contained magnesium aluminum hydroxide, viscous lidocaine, and diphenhydramine), 10 ml for every 3 h, six times a day, for 6 days. Both groups received same dietary and oral hygiene instructions and care. Mucositis was graded at baseline and every 3 days after treatment. Patients’ satisfaction and drug effect maintenance were also evaluated. Results: Twenty-eight patients (mean age of 49.5 ± 13.2 years, 63.3% female) completed the trial; 15 in the morphine group and 13 in the magic group. There was a decrease in mucositis severity in both of the morphine (P < 0.001) and magic (P = 0.049) groups. However, at the 6th day, more reduction was observed in mucositis severity in the morphine compared with magic group (P = 0.045). Drug effect maintenance was similar between the two groups, but patients in the morphine group were more satisfied by their treatments than those in the magic group (P = 0.008). Conclusions: Topical morphine is more effective and more satisfactory to patients than the magic mouthwash in reducing severity of cancer treatment-induced oral mucositis. More studies with larger sample size and longer follow-up are required in this regard.
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Affiliation(s)
- Mostafa Sarvizadeh
- Department of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Simin Hemati
- Department of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Meidani
- Department of Infectious Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Moghtada Ashouri
- Department of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Roayaei
- Department of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Armindokht Shahsanai
- Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Jo KS, Kim NC. [Incidence and factors influencing oral mucositis in patients with hematopoietic stem cell transplantation]. J Korean Acad Nurs 2014; 44:542-51. [PMID: 25381785 DOI: 10.4040/jkan.2014.44.5.542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to examine the incidence of oral mucositis in hematopoietic stem cell transplantation patients and to identify factors influencing oral mucositis and patient outcomes according to severity. METHODS In this retrospective study, data were collected from electronic medical records of 222 patients who had received hematopoietic stem cell transplantation. Oral mucositis was evaluated using WHO's assessment scale. Data were analyzed using Chi-square test, Fisher exact test, Spearman's correlation, Ordinal logistic regression, ANOVA and Kruskal-Wallis test. RESULTS A total of 69.8% of the patients evaluated developed oral mucositis (grade II and over). As a results of ordinal regression, factors influencing oral mucositis severity were found to be diagnosis, type of transplantation, oxygen inhalation and the number of antiemetics administration before transplantation. The severity of oral mucositis was found to increase the days of hospitalization, days of TPN administration, days of using antibiotics and the number and dosage of analgesics. CONCLUSION The results would help predict severity of oral mucositis in hematopoietic stem cell transplantation patients and suggest that provision of appropriate nursing assessment and oral care would improve patient outcomes.
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Affiliation(s)
- Kwan Suk Jo
- Graduate School, The Catholic University of Korea, Seoul, Korea
| | - Nam Cho Kim
- College of Nursing, The Catholic University of Korea, Seoul, Korea.
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19
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Bachmeier E, Mazzeo MA, López MM, Linares JA, Jarchum G, Wietz FM, Finkelberg AB. Mucositis and salivary antioxidants in patients undergoing bone marrow transplantation (BMT). Med Oral Patol Oral Cir Bucal 2014; 19:e444-50. [PMID: 24608218 PMCID: PMC4192566 DOI: 10.4317/medoral.19062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/16/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES High doses of chemotherapy generate DNA damage in patients undergoing bone marrow transplantation (BMT), due to the production of reactive oxygen species (ROS). In order to evaluate the local defensive effectiveness of the patient undergoing BMT, the concentrations of the antioxidants superoxide dismutase (SOD) and uric acid (UA) were measured in saliva. STUDY DESIGN Basal saliva samples were collected from 20 patients undergoing BMT at the Oncology Department, Sanatorio Allende (Córdoba), in the stages: initial, prior to conditioning therapy (I); middle: 7 to 10 days after BMT (M) and final stage, 30 days after discharge from isolation (F). SOD levels were determined using a RANDOX kit (RANSOD superoxide dismutase manual), and for uric acid enzymatic UOD / PAP spectrophotometric method, ( Trinder Color Kit , Wiener Lab) was used. RESULTS 85% of the patients developed oral mucositis. SOD concentration in the M stage was significantly higher (p<0.01) compared with stage I, and it reversed in stage F. UA concentration was significantly lower (p<0.001) in stage M compared with stage I, and in stage F it recovered the initial values. CONCLUSIONS SOD increase in stage M coincided with the appearance of mucositis, which could be interpreted as a defensive mechanism of saliva against oxidative stress produced by chemotherapy. UA decrease in stage M would favour the development of higher degrees of mucositis.
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Affiliation(s)
- Evelin Bachmeier
- Phisiology Department, University of Cordoba, Haya de La Torre S/N, Pabellón Argentina, Ciudad Universitaria, Córdoba, CP:5000 Córdoba, Argentina,
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Pimenta Amaral TM, Campos CC, Moreira dos Santos TP, Leles CR, Teixeira AL, Teixeira MM, Bittencourt H, Silva TA. Effect of salivary stimulation therapies on salivary flow and chemotherapy-induced mucositis: a preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:628-37. [PMID: 22668621 DOI: 10.1016/j.oooo.2011.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 10/06/2011] [Accepted: 10/15/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of salivary stimulation therapies on the salivary flow, oral mucositis, and salivary cytokine levels in patients receiving allogeneic hematopoietic stem cell transplantation. STUDY DESIGN Thirty-five eligible patients were randomized into 4 groups: control, mechanical sialogogue, transcutaneous electrical nerve stimulation (TENS) sialogogue, and combined mechanical/electrical sialogogue. Saliva was collected from patients before transplantation and at days 3, 7, and 14 after transplantation. The volume was measured and salivary cytokines were assessed using enzyme-linked immunosorbent assay. RESULTS By day 14, resting and stimulated salivary flow levels were diminished. Resting salivary flow rates decreased the most in the control and mechanical groups. In contrast, TENS alone or in combination with mechanical stimulatory therapy benefited the patients. TENS-treated patients showed increase in resting salivary flow. Also, the groups treated with TENS had fewer patients affected by grades 3 and 4 mucositis, and less mucositis was associated with better patient survival (P = .027). CONCLUSIONS TENS-associated salivary stimulation therapies minimized the reduction of salivary flow and prevented severe chemotherapy-induced oral mucositis.
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Affiliation(s)
- Tânia Mara Pimenta Amaral
- Department of Oral Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Hernández-Fernández A, Oñate-Sánchez RE, Cabrerizo-Merino MC, de Arriba-de la-Fuente F, Heras-Fernando I, Vicente-García V. Influence of oral health on mucositis in patients undergoing hematopoietic progenitor cell transplantation (HPCT). Med Oral Patol Oral Cir Bucal 2012; 17:e94-e101. [PMID: 22157660 PMCID: PMC3448185 DOI: 10.4317/medoral.16997] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 06/20/2011] [Indexed: 11/12/2022] Open
Abstract
Aims: To establish whether or not the state of patient oral health can influence the occurrence and/or severity of oral mucositis during hematopoietic progenitor cell transplantation (HPCT).
Materials and Methods: The study included 72 patients awaiting HPCT. Prior to transplantation, clinical exploration and radiology were carried out and oral photographs were taken. This evaluated the extent of caries present, the number of missing teeth and the number of dental fillings in each patient; CAO (Caries and Obturations Index) DMFS (Decayed, Missing, and Filled Surfaces) and Restoration Indices were calculated. Gingival pathology was also examined by means of the Ainamo and Bay Gingival Bleeding Index. O’Leary’s Plaque Index was used to evaluate the level of patient oral hygiene. This data was analyzed to see if it exercised any influence on the mucositis grade suffered during HPCT.
Results: 96,87% of patients suffered some degree of mucositis during their treatment by the Transplant Unit. The grade of mucositis was seen to be influenced by the number of missing teeth (ANOVA p<0.016) and by the DMFS Index (ANOVA p< 0.038). Although this was not one of the aims of this study, patient age and the administration of colony-stimulating factors were also seen to influence these clinical manifestations.
Conclusions: The state of prior oral health can influence decisively the mucositis suffered during transplantation. Key words: Hematopoietic progenitor cell transplantation, mucositis, state of oral health.
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Rodríguez-Caballero A, Torres-Lagares D, Robles-García M, Pachón-Ibáñez J, González-Padilla D, Gutiérrez-Pérez JL. Cancer treatment-induced oral mucositis: a critical review. Int J Oral Maxillofac Surg 2011; 41:225-38. [PMID: 22071451 DOI: 10.1016/j.ijom.2011.10.011] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 10/01/2011] [Accepted: 10/10/2011] [Indexed: 01/09/2023]
Abstract
Head and neck cancer represents one of the main oncological problems. Its treatment, radiotherapy and chemotherapy leads to mucositis, and other side effects. The authors reviewed high-quality evidence published over the last 25 years on the treatment of cancer treatment-induced oral mucositis. A Medline search for double blind randomized controlled clinical trials between 1985 and 2010 was carried out. The keywords were oral mucositis, radiotherapy, chemotherapy, and head and neck. The different therapeutic approaches found for cancer treatment-induced oral mucositis included: intensive oral hygiene care; use of topical antiseptics and antimicrobial agents; use of anti-inflammatory agents; cytokines and growth factors; locally applied non-pharmacological methods; antioxidants; immune modulators; and homoeopathic agents. To date, no intervention has been able to prevent and treat oral mucositis on its own. It is necessary to combine interventions that act on the different phases of mucositis. It is still unclear which strategies reduce oral mucositis, as there is not enough evidence that describes a treatment with a proven efficiency and is superior to the other treatments for this condition.
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Waśko-Grabowska A, Rzepecki P, Oborska S, Barzał J, Gawroński K, Młot B, Szczylik C. Efficiency of Supersaturated Calcium Phosphate Mouth Rinse Treatment in Patients Receiving High-Dose Melphalan or BEAM Prior to Autologous Blood Stem Cell Transplantation: A Single-Center Experience. Transplant Proc 2011; 43:3111-3. [DOI: 10.1016/j.transproceed.2011.08.053] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Weigelt C, Haas R, Kobbe G. Pharmacokinetic evaluation of palifermin for mucosal protection from chemotherapy and radiation. Expert Opin Drug Metab Toxicol 2011; 7:505-15. [PMID: 21417820 DOI: 10.1517/17425255.2011.566556] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Oral mucositis, one of the major side effects of chemotherapy and irradiation, is still a burden of modern oncology. The keratinocyte growth factor (KGF) palifermin has been approved as a new, targeted therapy for the prevention of severe oral mucositis. AREAS COVERED The authors review the literature on pharmacokintetics and clinical use of palifermin in patients with hematological malignancies and solid tumors for the prevention of chemo- and radiation-induced mucositis by using the PubMed database and additional literature where applicable. The article includes in vitro data, clinical trials as well as case reports regarding dosage, administration schedule, efficacy and adverse events. EXPERT OPINION There is sufficient data for a beneficial effect of palifermin prophylaxis for patients with hematological cancers receiving high-dose chemotherapy and total body irradiation as well as patients with head and neck cancer receiving combined irradiation and chemotherapy. In less mucotoxic regimens, dose and schedule of palifermin to achieve protection from mucositis are less well defined. The balance of benefit and unwanted effects has to be evaluated and weighed for individual chemotherapy regimens and patient groups. Further research on the prevention of mucositis should aim to determine the patient's individual risk to develop severe mucositis.
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Affiliation(s)
- Christian Weigelt
- Department of Hematology, Oncology and Clinical Immunology of the University Hospital of Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
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PCA analgesia for children with chemotherapy-related mucositis: a double-blind randomized comparison of morphine and pethidine. Bull Cancer 2011; 98:E11-8. [DOI: 10.1684/bdc.2011.1313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Crighton MH, Lingler JH, Happ MB. Fit and misfit. Res Gerontol Nurs 2011; 4:27-35. [PMID: 21210575 DOI: 10.3928/19404921-20101201-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 10/27/2010] [Indexed: 11/20/2022]
Abstract
This article presents an interpretive case analysis of an older adult's experience with treatment decision making for acute myeloid leukemia. Interview and observational data were compared and contrasted with key constructs in behavioral decision theory to analyze theoretical utility and fit. Decision making involved a complex interplay among the patient, treating clinicians, and family members. While some constructs of decision theory, such as trade-offs, avoidance-avoidance, and the certainty effect, showed utility for decision making in geriatric oncology, this case demonstrated that individual preferences for treatment may be expressed in quality of life preferences rather than a specific treatment decision. The Cage, a major theme in this case, represented the trap of two undesirable choices in treatment decision making, as well as the imprisoning consequence of aggressive medical treatment for advanced cancer. Further decision making research is needed to develop practice-level theory that can more effectively support and guide treatment decision making in geriatric oncology.
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Affiliation(s)
- Margaret H Crighton
- Department of acute and Tertiary Care, Department of Health and Community System, University of Pittsburg School of Nursing, Pittsburg, PA 15261, USA.
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Silva GBL, Mendonça EF, Bariani C, Antunes HS, Silva MAG. The Prevention of Induced Oral Mucositis with Low-Level Laser Therapy in Bone Marrow Transplantation Patients: A Randomized Clinical Trial. Photomed Laser Surg 2011; 29:27-31. [DOI: 10.1089/pho.2009.2699] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Geisa Badauy Lauria Silva
- Hematopoietic Stem Cell Transplant Unit, Araújo Jorge Hospital, Goiás Fight Cancer Association, Goiânia, Goiás, Brazil
| | | | - Cesar Bariani
- Hematopoietic Stem Cell Transplant Unit, Araújo Jorge Hospital, Goiás Fight Cancer Association, Goiânia, Goiás, Brazil
| | | | - Maria Alves Garcia Silva
- Department of Stomatology (Oral Pathology), Dental School, Federal University of Goiás, Goiânia, Goiás, Brazil
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Incidence and severity of oral mucositis in patients undergoing haematopoietic SCT--results of a multicentre study. Bone Marrow Transplant 2010; 46:727-32. [PMID: 20818449 DOI: 10.1038/bmt.2010.184] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oral mucositis (OM) is a common side effect experienced during haematopoietic SCT (HSCT), and it can have a significant impact on the quality of life of patients. A descriptive nurse-led study was undertaken in 19-member centres of the Italian national transplant group (GITMO) evaluating incidence, severity and duration of OM in patients undergoing HSCT. Data from 1841 patients between 2002 and 2006 was analyzed. Initial medical history and oral cavity assessment was performed. Assessment was repeated on the day of transplant, then daily, using the WHO (World Health Organisation) oral toxicity scale. A total of 71% of the patients evaluated developed mucositis and 21.6% developed severe mucositis. Duration of OM in most cases lasted for 10-14 days and resolved along with marrow reconstitution. Oral mucostitis is a frequent side effect in patients undergoing HSCT. The onset of severe mucositis seems to be related to the conditioning regimen used. This database provides a descriptive overview of the incidence and severity of mucositis and has encouraged participating centres to adopt routine evaluation and measurement of the oral cavity. The assessment tools are still used in some centres, providing a basis for further collaborative research projects.
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Abstract
The field of high-dose therapy and SCT has made many advances in the past several years and the success rates have been steadily increasing as newer therapies emerge and improvements in supportive care continue to improve patient survival and cure rates. There still remains a mortality risk for high-dose therapy and the need for palliative care becomes more apparent as the focus also incorporates quality of life in all facets of cancer treatment and care. This paper reports on the lack of literature available on palliative care into the BMT and explores areas of future research in the integration of these two fields of medicine.
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Affiliation(s)
- H M Chung
- Department of Internal Medicine, Division of Hematology/Oncology and Palliative Care, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
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Blocking LIF action in the uterus by using a PEGylated antagonist prevents implantation: a nonhormonal contraceptive strategy. Proc Natl Acad Sci U S A 2007; 104:19357-62. [PMID: 18042698 DOI: 10.1073/pnas.0710110104] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Blastocyst implantation is a critical stage in the establishment of pregnancy. Leukemia inhibitory factor (LIF) is essential for mouse blastocyst implantation and also plays a role in human pregnancy. We examined the effect of a potent LIF antagonist (LA) on mouse implantation. In mice, LIF expression peaks on day 3.5 of pregnancy (D3.5) (D0.5 = day of mating plug detection) in the uterine glandular epithelium. LA (7 mg/kg per day) administered from D2.5 to D4.5 via four hourly i.p. injections plus continuous administration via miniosmotic pump resulted in complete implantation failure. To improve its pharmacokinetic properties, we conjugated LA to polyethylene glycol (PEG), achieving a significant increase in serum levels. PEGylated LA (PEGLA) (37.5 mg/kg per day) administered via three i.p. injections between D2.5 and D3.5 also resulted in complete implantation failure. PEGLA immunolocalized to the uterine luminal epithelium at the time of blastocyst implantation. Both LA and PEGLA reduced phosphorylation of the downstream signaling molecule STAT3 in luminal epithelial cells on D3.5. The effects of PEGLA were found to be endometrial, with no embryo-lethal effects observed. These data demonstrate that administration of a PEGylated LIF antagonist is an effective method of targeting LIF signaling in the endometrium and a promising novel approach in the development of nonhormonal contraceptives for women.
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Sheean PM, Braunschweig CA. Exploring the Clinical Characteristics of Parenteral Nutrition Recipients Admitted for Initial Hematopoietic Stem Cell Transplantation. ACTA ACUST UNITED AC 2007; 107:1398-403. [PMID: 17659908 DOI: 10.1016/j.jada.2007.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Indexed: 12/13/2022]
Abstract
There is a paucity of evidence to guide the initiation of parenteral nutrition administration during hematopoietic stem cell transplantation. The purpose of this study was to explore and compare clinical characteristics during early hematopoietic stem cell transplantation to discern if differences existed between those that had parenteral nutrition initiated and those that did not. Medical records of patients admitted for initial autologous or allogeneic hematopoietic stem cell transplantation from two university transplantation centers were evaluated for this retrospective cohort. A multitude of clinical features were evaluated at baseline and in the days preceding parenteral nutrition initiation to investigate potential differences between parenteral nutrition and non-parenteral nutrition subjects, stratified by donor type. To examine the occurrence of events prior to parenteral nutrition administration, a "before" time frame was created for all subjects. For parenteral nutrition subjects, the actual number of hospital days prior to parenteral nutrition initiation was used; however, for non-parenteral nutrition patients, the transplantation-specific average number of days until parenteral nutrition initiation, depicted as "before" (ie, autologous non-parenteral nutrition "before"=hospital days 1 to 10, allogeneic non-parenteral nutrition "before"=hospital days 1 to 13), was used during this parallel timeframe. Differences were assessed using Student's t and Wilcoxon rank sum tests for continuous variables, and chi(2) for categorical variables. Parenteral nutrition was provided to 53% (n=129/245) of autologous and 65% (n=73/112) of allogeneic patients and was typically initiated on transplant day +6 and day +7, respectively. Significant decreases in oral intake patterns (P<0.0001) and a tendency toward infections were observed for autologous (P=0.01) and allogeneic (P=0.07) parenteral nutrition vs non-parenteral nutrition recipients "before." In addition, significantly more mucositis was observed "before" in allogeneic parenteral nutrition vs non-parenteral nutrition patients (P=0.04). Involvement of nutrition professionals is crucial for the design and implementation of future studies to determine for whom and when to commence parenteral nutrition and to discourage its indiscriminant use.
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Affiliation(s)
- Patricia M Sheean
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Beaven AW, Shea TC. Palifermin: a keratinocyte growth factor that reduces oral mucositis after stem cell transplant for haematological malignancies. Expert Opin Pharmacother 2006; 7:2287-99. [PMID: 17059384 DOI: 10.1517/14656566.7.16.2287] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mucositis occurs in < or = 98% of patients undergoing stem cell transplant for haematological malignancies and is associated with significant morbidity and mortality. Patients with severe mucositis have more pain, more difficulty with daily activities such as talking and eating, and are more likely to have bacteraemia. Palifermin is a keratinocyte growth factor that has been shown to decrease severity and duration of mucositis with a concurrent decrease in patient-reported symptoms and use of narcotics and total parenteral nutrition. Research is ongoing into palifermin's potential ability to decrease graft-versus-host disease and improve reconstitution of functional T lymphocytes after allogeneic stem cell transplant, to hasten wound healing and to reduce mucositis following external beam radiation therapy in solid tumour patients.
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Affiliation(s)
- Anne W Beaven
- University of North Carolina, Hematology/Oncology, Chapel Hill, NC 27599, USA.
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Lilleby K, Garcia P, Gooley T, McDonnnell P, Taber R, Holmberg L, Maloney DG, Press OW, Bensinger W. A prospective, randomized study of cryotherapy during administration of high-dose melphalan to decrease the severity and duration of oral mucositis in patients with multiple myeloma undergoing autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 2006; 37:1031-5. [PMID: 16633359 DOI: 10.1038/sj.bmt.1705384] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Forty patients with multiple myeloma scheduled to receive melphalan 200 mg/m(2) followed by autologous stem cell transplantation were randomly assigned to receive oral cryotherapy or room temperature normal saline rinses 30 min before and for 6 h after high-dose therapy. Patients were evaluated for the development of mucositis using the National Cancer Institute grading system as well as evaluation of secondary measures such as days of total parenteral nutrition (TPN), narcotic use, hospitalization, weight loss and resumption of oral caloric intake for 28 days after transplant. Patients self-scored their pain, swallowing, drinking, eating, sleeping and taste alterations for 28 days. The primary end point of this trial was the incidence of grades 3-4 mucositis. Compared to the normal saline group, patients using cryotherapy experienced less grade 3-4 mucositis, 14 vs 74%, P=0.0005. Patients receiving cryotherapy also had statistically lower uses of narcotics and TPN, although there were no differences in length of hospitalization or weight loss. Patient-reported pain was significantly lower and activities were significantly better in the cryotherapy group.
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Affiliation(s)
- K Lilleby
- Fred Hutchinson Cancer Research Center, the Seattle Cancer Care Alliance and the University of Washington, 1100 Fairview Avenue N., Seattle, WA 98109, USA
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Radtke ML, Kolesar JM. Palifermin (Kepivance) for the treatment of oral mucositis in patients with hematologic malignancies requiring hematopoietic stem cell support. J Oncol Pharm Pract 2006; 11:121-5. [PMID: 16390600 DOI: 10.1191/1078155205jp159oa] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To provide a comprehensive review of the clinical use of the recombinant biological agent, palifermin, with particular reference to its use in its approved indication, oral mucositis resulting from high dose chemotherapy and radiation in patients with hematologic malignancies requiring hematopoietic stem cell support. DATA SOURCES A MEDLINE search was conducted using the terms 'palifermin' and 'Kepivance.' All data available from MEDLINE were reviewed. The reference lists from retrieved articles were reviewed and other relevant papers were identified. DATA SUMMARY Keratinocyte growth factor (KGF) is a growth factor that acts specifically on epithelial cells playing a role in proliferation, migration, and morphogenesis. Palifermin is a recombinant human form of KGF. Because of its ability to cause proliferation of the oral mucosa and to protect against mucosal injury, palifermin is a treatment option for patients who are at high risk for oral mucositis, specifically patients with hematological malignancies receiving stem cell transplantation (SCT). In a phase III study of these patients, the overall incidence of World Health Organization (WHO) grade 3 or 4 oral mucositis was significantly reduced in the palifermin group (palifermin = 63% versus placebo = 98%, P < 0.001). Among the patients who experienced WHO grade 3 or 4 oral mucositis the average duration of this grade of mucositis in the palifermin group was six days compared with nine days in the placebo group (P < 0.001). Common adverse effects of palifermin include pruritus, erythema, mouth and tongue disorders, and taste alterations.
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Gabriel DA, Shea TC, Serody JS, Moore DT, Kirby SL, Harvey D, Krasnov C. Cytoprotection by Amifostine during Autologous Stem Cell Transplantation for Advanced Refractory Hematologic Malignancies. Biol Blood Marrow Transplant 2005; 11:1022-30. [PMID: 16338625 DOI: 10.1016/j.bbmt.2005.08.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Accepted: 08/10/2005] [Indexed: 11/24/2022]
Abstract
This study evaluated whether amifostine protects against mucositis and other toxicities in patients with advanced, refractory, or recurrent hematologic malignancies undergoing high-dose chemotherapy and total body irradiation. Thirty-five patients (20 with non-Hodgkin lymphoma, 12 with Hodgkin disease, and 3 with acute myelogenous leukemia) who underwent autologous stem cell transplantation were conditioned with total body irradiation 2 Gy twice daily on days -8 through -6; cyclophosphamide 6 g/m(2), etoposide 1.8 g/m(2), and carboplatin 1 g/m(2) on days -5 through -3; and amifostine 500 mg/m(2) on days -8 through -2. Prior institutional experience in patients treated without amifostine was used as a historical comparison (no-amifostine group). Severe mucositis occurred in 14 (40%) of 35 patients in the amifostine group, compared with 33 (94%) of 35 in the no-amifostine group (P < .0001). Total parenteral nutrition was used by 4 (11%) of 35 amifostine-treated patients and 34 (97%) of 35 no-amifostine patients (P < .0001). The median duration of narcotic use decreased from 15.5 days with no amifostine to 11 days with amifostine (P = .002). Granulocyte and platelet engraftment times were similar. Prospective trials with innovative designs and clearly defined stopping rules are warranted to confirm whether amifostine reduces the toxicities of a myelosuppressive conditioning regimen before autologous stem cell transplantation without compromising therapeutic response.
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Affiliation(s)
- Don A Gabriel
- Division of Hematology/Oncology, Bone Marrow Transplant Program, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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Kallianpur AR. Genomic screening and complications of hematopoietic stem cell transplantation: has the time come? Bone Marrow Transplant 2005; 35:1-16. [PMID: 15489868 DOI: 10.1038/sj.bmt.1704716] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The occurrence of toxic complications following hematopoietic stem cell transplantation (HSCT) is highly variable and dependent on a multitude of host, donor, and treatment factors. The increasingly broad indications for HSCT and the need to provide this treatment option to older and/or more debilitated patients emphasizes the importance of refining our methods of predicting and ameliorating these toxicities. Late complications (occurring after day 100) also pose a threat to quality of life after HSCT. Genetic polymorphisms in key molecular pathways in the host are likely to contribute significantly to the observed variability in the development HSCT-associated complications. Hepatic veno-occlusive disease and acute lung injury, two of the most serious organ toxicities that occur, represent useful paradigms for the identification of genetic polymorphisms in enzyme systems that modulate local and systemic responses to oxidant stress during transplant conditioning therapy. Ongoing studies in this area are providing clues to the prevention of adverse clinical outcomes based on the genetic milieu. This review of studies in HSCT that explore genetic risk factors for transplant complications indicates that significant progress is being made in this rapidly evolving area. However, further large-scale clinical and translational studies are needed before genomic screening can be widely used to individualize treatment.
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Affiliation(s)
- A R Kallianpur
- Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center and TN Valley Health Services VA Medical Center, 1310 24th Avenue South, Nashville, TN 37212, USA.
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West F, Mitchell SA. Evidence-based guidelines for the management of neutropenia following outpatient hematopoietic stem cell transplantation. Clin J Oncol Nurs 2005; 8:601-13. [PMID: 15637955 DOI: 10.1188/04.cjon.601-613] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) involves the transfer of stem cells to establish hematopoiesis in patients who have received myeloablative chemotherapy with or without whole body irradiation. Following high-dose therapy and HSCT, all patients experience a period of neutropenia. Outpatient care delivery models place expanded responsibilities on patients and their families for the management of this treatment side effect. Proactive management of neutropenia is critical to decrease the depth and duration of neutropenia following HSCT, limit exposure to opportunistic and nosocomial pathogens, and ensure prompt intervention should febrile neutropenia or infection develop. Patient and family education, psychosocial support, and coordination of care are key nursing responsibilities.
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Affiliation(s)
- Fran West
- Cancer Center Methodist University Hospital, Memphis, TN, USA.
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Barker GJ, Epstein JB, Williams KB, Gorsky M, Raber-Durlacher JE. Current practice and knowledge of oral care for cancer patients: a survey of supportive health care providers. Support Care Cancer 2004; 13:32-41. [PMID: 15549427 DOI: 10.1007/s00520-004-0691-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Accepted: 08/10/2004] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Oral Care Study Section of the Multinational Association of Supportive Care in Cancer (MASCC) and the International Society for Oral Oncology (ISOO) conducted a survey on clinical practices of oral/dental management of cancer patients among supportive health care providers. The main purpose was to evaluate the knowledge and current practice for preventing and managing oral side effects associated with intensive chemotherapy (ICT), hematopoietic cell transplant (HCT), and radiation therapy to the head and neck (H&N RT). MATERIALS AND METHODS A questionnaire designed and pretested was sent to 212 MASCC/ISOO members around the world with different dental and medical backgrounds. MAIN RESULTS Seventy-four individuals (35%) responded. The majority of respondents were aware of possible oral complications and provided patients with clinical strategies and recommendations although there was considerable variability among the respondents. Approximately 75% stated that patients were referred for oral/dental care prior to H&N RT and ICT including HCT. However, integrated dental and medical services were reported available in only about 25% of the institutions, and most patients were referred to community-based dental professionals. MAIN CONCLUSIONS The survey represents a first review of current, international oral care practices. It suggests a need to develop evidence-based clinical guidelines to support effective oral/dental interventions and management strategies for this population. Furthermore, strategies for implementation of oral care protocols and better integration of dental and medical services should be developed. Caution in interpreting these findings is urged due to the limited response rate.
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Affiliation(s)
- Gerry J Barker
- Department of Dental Public Health and Behavioral Science School of Dentistry, University of Missouri Kansas City, 650 E 25th Street, Kansas City, MO 64108, USA.
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