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.

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 200 mg/m2 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 200 mg/m2 conditioning regimen (18% OM in cryotherapy vs. 68% without it, p<0.0001) and in the multidrug BEAM (melphalan 140 mg/m2) 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.

BACKGROUND:Gelclair is an oral lubricating gel used in the management of oral mucositis (OM). We evaluated its efficacy, tolerance and impact on oral cavity microbial colonization in patients with OM after allogeneic hematopoietic stem cells transplantation.MATERIAL/METHOD:Gelclair was administered in a group of 22 patients with active OM. A control group of 15 patients used other rinsing solutions (chlorhexidine, benzydamine, salvia). Tests with oral cavity swabs for microbiology analysis were performed once a week.RESULTS:The characteristics of OM in both groups were comparable, and rinsing solutions had satisfactory tolerability. There was no difference in the median improvement of oral intake and OM-related pain relief, which was assessed mostly as "slight effect". In the Gelclair group, the effect duration was longer (median 3 [0-5] vs. 1 [0-3] hours, p = 0.001). There was significant increase of Enterococcus faecalis and Candida sp. colonization of the oral cavity over the course of the hospitalization and significantly reduced incidence of such colonization in patients with OM in the Gelclair group: 1/22 (5%) vs. 6/15 (40%), p = 0.01. In vitro tests showed inhibited growth of Enterococcus faecalis and Candida sp. colonies within the area of the Gelclair application.CONCLUSIONS:Gelclair may be individually helpful in the management of OM and pain in patients after allogeneic stem cells transplantation. Its use did not lead to worsened oral bacterial and yeast colonization and probably even helped to protect mucosa from Enterococcus and Candida sp. Further studies based on larger cohorts are needed.

Orofaryngealni mukozitida (OM) je významnou a bolestivou komplikaci u pacientů po vysokodavkovane chemoterapii zajistěne autologni nebo alogenni transplantaci krvetvorných buněk. Bylo publikovano několik dobrých zkusenosti s využitim transdermalniho fentanylu v lecbě OM bolesti. Analyzovali jsme výsledky lecby bolesti transdermalnim buprenorfinem (TB) u 51 pacientů s OM po alogenni transplantaci krvetvorných buněk. U 82 % pacientů nedochazelo k progresi intenzity bolesti v uvodnich třech až pěti dnech lecby s TB v davce 35 μg/hodinu nebo 52,5 μg/hodinu. Významný pokles intenzity bolesti byl pozorovan po pěti až sedmi dnech. Lecba byla obecně velmi dobře tolerovana. TB je možne zvažovat jako lecbu bolesti u pacientů s vysokým rizikem postiženi těžkou a dlouhodobě trvajici OM. Pro definitivni doporuceni jsou vsak potřebna dalsi sledovani a studie.

Only a minimum is known about clinical effect of antimicrobial-coated central venous catheters (CVC) in stem cell transplantation settings, where CVC-related infections impose major threat to severely immunocompromised patients.

Background Changing a central venous catheter occlusive dressing on a twice-weekly basis is usually recommended in hemato-oncological patients. A longer interval is believed to give rise to infections. However, frequent dressing changes might cause local cutaneous damage. Material/methods Local cutaneous damage and infections were compared in patients with once-weekly versus twice-weekly changes of central venous catheters occlusive dressings. This was a prospective, randomized, multicenter trial. Results Eighty-one patients with acute myeloid leukemia being treated with intensive chemotherapy were enrolled (twice-weekly group: n=42, once-weekly group: n=39). They had a non-tunneled polyurethane central venous catheter inserted into the vena subclavia and the insertion site was covered by a polyurethane semi-permeable occlusive dressing. No differences were observed between the groups with respect to local cutaneous damage, fevers, or positive catheter blood cultures. There were more insertion-site inflammations in the twice-weekly group (55% vs. 25%, p=0.008). In the once-weekly group it was necessary to change the occlusive dressing sooner in 42% of the cases, mostly due to a soiled dressing and local bleeding, and the real mean interval of changes was 5.4 days. Conclusions Prolonging the frequency of occlusive dressing change to a once-weekly interval was limited by an increasing number of unplanned dressing changes. The prolonged interval of dressing changes, with a real mean interval of 5.4 days, did not lead to an increased number of local cutaneous complications or central venous catheter blood culture positivity and even contributed to reduced insertion-site inflammation occurrence.

Study on the normal saline vs povidone-iodine mouthwashes for oral mucositis (OM) prophylaxis in patients after high-dose chemotherapy comprising bischloroethyl nitrosourea etoposide ara-C melphalan (BEAM) or high-dose melphalan (HD-L-PAM) followed by autologous peripheral stem cell transplantation indicated that females have higher a incidence of OM compared to men, as reported by [Vokurka et al. 13:554-558, (2005)]. The multivariable analysis of larger cohort of 148 patients compliant with the original study protocol confirmed female gender to be an independent risk factor and predictor for OM. The HD-L-PAM (200 mg/m(2)) conditioning regimen revealed to be more toxic compared to BEAM as for incidence of OM grades 3-4 World Health Organization score. Body mass index, age, mouthwash solution used, and CD34(+) cell number in the autologous graft were verified not to have an impact on OM incidence in this group of patients.

Antimicrobial solutions are widely used in the nursing care of chemotherapy induced oral mucositis (OM). There is little evidence, however, supporting their use for reducing mucosal damage. In our study, 132 patients were randomized to use normal saline (n=65) or povidone-iodine diluted 1:100 (n=67) mouthwashes for OM prophylaxis and treatment after high-dose chemotherapy comprising BEAM or HD-L-PAM followed by autologous peripheral stem cell transplantation. The study groups were well balanced in respect of age, sex, chemotherapy and the number of CD34+ cells in the graft. No significant difference was found between the groups in respect of OM characteristics, fever of unknown origin (FUO) and other infections. The antimicrobial solution was less tolerable for patients. OM occurred significantly more often in females than in males (86% vs 60%, P=0.0016) and was worse and of longer duration. The mechanical effect of mouthwashes might have a certain importance in FUO prevention. When indicating oral rinses, the patient’s individual preference and tolerance of solutions offered should be considered.