Vera-Llonch Montserrat, Oster Gerry, Ford Colleen M, Lu John, Sonis Stephen
Policy Analysis Inc. (PAI), Brookline, Massachusetts 02445, USA.
J Support Oncol. 2007 May;5(5):231-5.
The purpose of this study was to assess the relationship between oral mucositis (OM) and adverse clinical and economic outcomes of autologous hematopoietic stem-cell transplantation (HSCT) following high-dose melphalan (Alkeran) conditioning in patients with multiple myeloma. A retrospective study of 115 consecutive autologous HSCT recipients with multiple myeloma who received high-dose melphalan conditioning before transplantation was undertaken at a single academic center. OM severity was assessed twice weekly using a validated scale beginning 3-4 days following conditioning and continuing until hospital discharge or day 28, whichever occurred first. OM was graded, based on presence/extent of erythema/ulceration across eight oropharyngeal sites, as follows: 0 = no erythema or ulceration; I = erythema but no ulceration; II = ulceration, 1 site; III = ulceration, 2 sites; IV = ulceration, 3 sites; and V = ulceration, > or = 4 sites. Analyses examined the relationship between worst OM grade and selected clinical and economic outcomes, including days with fever, days of total parenteral nutrition (TPN),days of parenteral narcotic therapy, incidence of significant infection, and inpatient days and charges. The mean age of study subjects was 54 years; 19 patients (17%) received total-body irradiation, and 55 patients (48%) experienced OM grade > or = II (ie, ulceration). The worst OM grade was significantly (P < 0.05) associated with numbers of days of TPN and parenteral narcotic therapy, length of hospitalization, and total inpatient charges. Worst OM grade was not associated with the number of febrile days or the risk of significant infection. OM is associated with worse clinical and economic outcomes in multiple myeloma patients undergoing autologous HSCT following high-dose melphalan conditioning.
本研究的目的是评估多发性骨髓瘤患者在接受大剂量美法仑（马法兰）预处理后进行自体造血干细胞移植（HSCT）时，口腔黏膜炎（OM）与不良临床及经济结局之间的关系。在一个学术中心对115例连续接受大剂量美法仑预处理的自体HSCT多发性骨髓瘤患者进行了一项回顾性研究。从预处理后3 - 4天开始，每周两次使用经过验证的量表评估OM严重程度，持续至出院或第28天，以先发生者为准。根据八个口咽部位的红斑/溃疡情况对OM进行分级，如下：0级 = 无红斑或溃疡；I级 = 有红斑但无溃疡；II级 = 1个部位溃疡；III级 = 2个部位溃疡；IV级 = 3个部位溃疡；V级 = 4个及以上部位溃疡。分析研究了最差OM分级与选定的临床和经济结局之间的关系，包括发热天数、全胃肠外营养（TPN）天数、胃肠外麻醉治疗天数、严重感染发生率、住院天数和费用。研究对象的平均年龄为54岁；19例患者（17%）接受了全身照射，55例患者（48%）发生了II级及以上OM（即溃疡）。最差OM分级与TPN天数、胃肠外麻醉治疗天数、住院时间和住院总费用显著相关（P < 0.05）。最差OM分级与发热天数或严重感染风险无关。在接受大剂量美法仑预处理后进行自体HSCT的多发性骨髓瘤患者中，OM与更差的临床和经济结局相关。
