Asunto(s)
Crioterapia/métodos , Fiebre de Origen Desconocido/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Melfalán/efectos adversos , Estomatitis/etiología , Antibacterianos/uso terapéutico , Estudios de Cohortes , Femenino , Fiebre de Origen Desconocido/tratamiento farmacológico , Fiebre de Origen Desconocido/fisiopatología , Estudios de Seguimiento , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Incidencia , Mucosa Intestinal/fisiopatología , Masculino , Melfalán/uso terapéutico , Estudios Prospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estomatitis/epidemiología , Trasplante Autólogo , Resultado del TratamientoRESUMEN
PURPOSE: Oral mucositis (OM) still represents a significant complication of hematopoietic stem cell transplantations (HSCT). Observational studies focusing on risk factor definitions are still warranted. METHOD: A total of 126 patients participated in this observational study after autologous HSCT with the BEAM and HD-l-PAM 200mg/m(2) conditioning regimens. Basic clinical and laboratory variables and their impact on OM were assessed. RESULTS: Age, gender, body mass index, and baseline absolute neutrophil counts were not shown to have any negative impact on OM development. The multivariate analysis revealed oral cryotherapy non-provision as being the most significant predictor for OM incidence (p < 0.0001), followed by BEAM conditioning regimen (p = 0.007), OM in a patient's history (p = 0.002) and lower number of days since the last chemotherapy (p = 0.025). The cryotherapy was remarkably effective both in the single high-dose melphalan 200mg/m(2) conditioning regimen (18% OM in cryotherapy vs. 68% without it, p<0.0001) and in the multidrug BEAM (melphalan 140mg/m(2)) regimen (38% vs. 86%, p=0.006). CONCLUSION: Oral cryotherapy should be implemented into supportive care management in patients treated with high-dose melphalan short-infusion chemotherapy. Large and well-designed randomized trials are necessary to obtain more significant and reliable results and understanding regarding OM risk factors.