Busemann Christoph, Wilfert Hanna, Neumann Thomas, Kiefer Thomas, Dölken Gottfried, Krüger William H
Department of Internal Medicine C - Haematology, Oncology and Stem Cell Transplantation, University Hospital Greifswald, Ernst Moritz Arndt University Greifswald, Germany.
Onkologie. 2011;34(10):518-24. doi: 10.1159/000332131. Epub 2011 Sep 16.
Therapyrelated mucositis is associated with considerable morbidity. This complication following allogeneic stem cell therapy (alloSCT) is less severe after reduced intense conditioning (RIC); however, even here it may be serious.
52 patients (male: n = 35 (67%), female: n = 17 (33%)) at a median age of 62 years (35-73 years) underwent alloSCT after RIC. Conditioning was either total body irradiation (TBI)(2Gy)/±fludarabine (n = 33, 63.5%) or chemotherapy based. Graftversushost disease (GvHD) prophylaxis was carried out with cyclosporine A ± mycophenolate mofetil (MMF). 45 patients (87%) received shortcourse methotrexate (MTX). Mucositis was graded according to the Bearman and the World Health Organisation (WHO) scale. A variety of parameters were correlated with mucositis.
The Bearman and WHO scales showed excellent correlation. Mucositis was significantly more severe after chemotherapybased conditioning compared to conditioning with TBI(2Gy)/±fludarabine (p < 0.002) as well as in cases with an increase in creatinine levels above the upper normal value (UNV) on day +1 after SCT (p < 0.05). Furthermore, the severity correlated with time to engraftment of leucocytes (correlation coefficient (cc) = 0.26, p < 0.02) and thrombocytes (cc = 0.38, p < 0.001).
The conditioning regimen and increased creatinine levels at day +1 were identified as factors predicting the severity of mucositis after RICSCT. Creatinine levels on day +1 after SCT may help identify patients at risk for severe mucositis in the further course of transplantation.
治疗相关的粘膜炎与相当高的发病率相关。异基因干细胞治疗（alloSCT）后的这种并发症在减低强度预处理（RIC）后较轻；然而，即便如此它也可能很严重。
52例患者（男性：n = 35例（67%），女性：n = 17例（33%）），中位年龄62岁（35 - 73岁），接受了RIC后的alloSCT。预处理方案为全身照射（TBI）（2Gy）/±氟达拉滨（n = 33例，63.5%）或基于化疗的方案。移植物抗宿主病（GvHD）预防采用环孢素A ± 霉酚酸酯（MMF）。45例患者（87%）接受了短疗程甲氨蝶呤（MTX）。粘膜炎根据贝尔曼和世界卫生组织（WHO）的标准进行分级。多种参数与粘膜炎相关。
贝尔曼和WHO标准显示出极好的相关性。与采用TBI（2Gy）/±氟达拉滨的预处理相比，基于化疗的预处理后粘膜炎明显更严重（p < 0.002），以及在SCT后第1天肌酐水平高于正常上限值（UNV）的病例中也是如此（p < 0.05）。此外，严重程度与白细胞植入时间（相关系数（cc） = 0.26，p < 0.02）和血小板植入时间（cc = 0.38，p < 0.001）相关。
预处理方案以及SCT后第1天肌酐水平升高被确定为预测RIC - SCT后粘膜炎严重程度的因素。SCT后第1天的肌酐水平可能有助于识别在移植后续过程中发生严重粘膜炎风险的患者。
