Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-HaShomer, Sackler School of Medicine, Tel Aviv University, Ramat-Gan, Israel.
Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Ramat-Gan, Israel.
Eur J Haematol. 2019 Oct;103(4):402-409. doi: 10.1111/ejh.13299. Epub 2019 Aug 12.
Oral mucositis (OM) is a common toxicity of stem cell transplantation (SCT). We sought to evaluate OM burden, risk factors, and implications in a cohort of allogeneic-SCT recipients.
This was a single-center study including 115 adult allogeneic-SCT transplanted between 2016 and 2018 for various hematological conditions. Conditioning intensity was categorized as myeloablative (MAC, 39%), reduced intensity (34%), or reduced toxicity (RTC, 27%) in patients conditioned with fludarabine-treosulfan. OM was prospectively graded using the Common Terminology Criteria for Adverse Events (v.4.0) system.
Moderate-to-severe OM (grade 2-4) was experienced by 60% of patients. In a univariate analysis, younger age (P = .023), lower body mass index (P = .01), recent smoking (P = .08), recent antibiotics exposure (P = .018), MAC (P < .001), and methotrexate (P = .009) were associated with moderate-to-severe OM. In a multivariable logistic regression model, conditioning and graft-versus-host disease prophylaxis remained significant. OM risk was lowest with RTC (RTC vs MAC: odd ratio [OR] 0.05, P < .001), and recent antibiotic exposure trended toward increased risk (OR 1.88, P = .168). OM was associated with longer hospitalization, delayed neutrophil engraftment, and gastrointestinal-related infections.
Oral mucositis remains a leading SCT complication. Treosulfan-based conditioning has low mucosal toxicity and is appealing given previous reports on its high efficacy.
口腔黏膜炎（OM）是干细胞移植（SCT）的常见毒性反应。我们旨在评估同种异体 SCT 受者队列中的 OM 负担、风险因素及其影响。
这是一项单中心研究，纳入了 2016 年至 2018 年间因各种血液疾病接受同种异体 SCT 的 115 例成年患者。在接受氟达拉滨-曲奥舒凡预处理的患者中，根据预处理强度分为清髓性（MAC，39%）、强度减低（34%）或减低毒性（RTC，27%）。采用不良事件常用术语标准（v.4.0 版）系统对 OM 进行前瞻性分级。
60%的患者发生中重度 OM（等级 2-4）。单因素分析显示，年龄较小（P=.023）、体重指数较低（P=.01）、近期吸烟（P=.08）、近期抗生素暴露（P=.018）、MAC（P<.001）和甲氨蝶呤（P=.009）与中重度 OM 相关。多变量逻辑回归模型显示预处理和移植物抗宿主病预防仍有显著意义。RTC 风险最低（RTC 与 MAC：比值比[OR]0.05，P<.001），近期抗生素暴露呈增加风险趋势（OR 1.88，P=.168）。OM 与住院时间延长、中性粒细胞植入延迟和胃肠道相关感染有关。
口腔黏膜炎仍是 SCT 的主要并发症。基于曲奥舒凡的预处理具有较低的黏膜毒性，且先前有报道称其疗效较高，因此具有吸引力。
