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The impact of oral cryotherapy and oral and gastrointestinal mucositis after autologous stem cell transplantation

2013; Elsevier BV; Volume: 18; Issue: 2 Linguagem: Inglês

10.1016/j.ejon.2013.11.001

1532-2122

Samuel Vokurka, Ivana Chvojkova, Tomáš Svoboda, Renata Brandejsová, Alexandra Jungová, Eva Bystřická, Pavel Jindra,

Head and Neck Cancer Studies

Oral mucositis (OM) is a significant post-transplant complication and is considered a risk factor for infection, prolonged hospitalization, and need for parenteral nutrition and analgesia ( Masszi and Mank, 2012 Masszi T. Mank A. Supportive care. in: Apperley J. Carreras E. Gluckman E. Masszi T. The 2012 Revised Edition of the ESH-EBMT Handbook on Haemopoietic Stem Cell Transplantation. Forum Service Editore, Genoa2012: 157-174 Google Scholar ). Oral cavity cooling (cryotherapy) provided during high-dose melphalan short infusion is an established method for reducing the incidence of OM ( Keefe et al., 2007 Keefe D.M. Schubert M.M. Elting L.S. Sonis S. Epstein J.B. Raber-Durlacher J.E. et al. Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer. 2007; 109: 820-831 Crossref PubMed Scopus (598) Google Scholar ). In order to examine the relationship between cryotherapy, OM, and gastrointestinal mucositis (GIM) on the incidence of fevers of unknown origin (FUO), intravenous (IV) antibiotic use, and analgesic administration, we prospectively analysed 245 patients receiving HD-L-PAM 200 (n = 161) or BEAM (n = 84) autologous stem cell transplantation. The first 154 patients were not given oral cryotherapy, since this was only implemented in our unit in 2009. Cryotherapy with ice lollipops or crushed ice started 5 min prior to melphalan administration, continued during the 15-min infusion, and for 15 min afterwards. The patients were instructed to keep the ice or water in their mouth, to gargle it, and to spit it out or swallow it occasionally. Oral mouthwashes with povidone-iodine, benzydamine, salvia officinalis, and most commonly chlorhexidine (in 81% of patients) were provided during hospitalization after a main meal and before sleep. Standard antimicrobial prophylaxis (quinolones and fluconazole) was administered, and 150 mg tramadol was administered per diem as requested for painful OM. IV antibiotics (cephalosporins as first line treatment) were administered for at least three days in neutropenic patients in cases of fever (≥38.0 °C) or patients with 24-h of persistently elevated body temperature (≥37.5 °C). Trained medical staff assessed OM using the WHO grading scale (0–4). Filgrastim 5 μg/kg/day was administered to the engraftment during neutropenia. Since no validated objective tool is currently available for the assessment of GIM in daily practice, we defined GIM as pathogen-negative cultured diarrhoea occurring at least three times per day post-transplant. Basic statistical analyses (Fishers test and unpaired t-test) were performed using statistical software (GraphPad, La Jolla); multivariate analysis was performed by an independent statistician.