SpringerLink
Log in

A prospective study of incidence, clinical and quality of life consequences of oral mucositis post palifermin prophylaxis in patients undergoing high-dose chemotherapy and autologous hematopoietic cell transplantation

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Autologous hematopoietic cell transplantation (AHCT) has presented a revolutionary advance in the management of hematologic malignancies with low toxicity. However, oral mucositis (OM) remains a distressing toxic effect of AHCT and one of the major side effects of the conditioning. This prospective, observational study aimed to evaluate the severity of oral cavity pain and quality of life (QOL) and explore incidence, duration, and potential risk factors of moderate/severe OM. Thirty-nine patients receiving prophylactic palifermin post-AHCT were enrolled. QOL and severity of pain were assessed using validated questionnaires (Functional Assessment of Cancer Therapy-General (FACT-G) and mouth and throat soreness (MTS), respectively). The incidence of moderate/severe OM was 28.2 % with a median duration of 5 days and was associated with younger age and female gender. Severity of pain related to OM was generally low or moderate with only 25 % of patients reporting a score >6 on the MTS scale of 0–10 on day +7. Health-related QOL was worse on day +7 in the transplant unit compared to day 1, while on discharge day, all scores recovered and the total FACT-G score was not different from that on day 1. In our population, the incidence and duration of OM and the severity of pain related to OM appeared to be lower compared to that reported in previous studies. The impact of OM on QOL assessments seemed to be reversible with optimal supportive care despite the major transient disabilities mainly attributable to OM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Farooq U, Laport GG (2014) Recent progress: hematopoietic cell transplantation for diffuse large B cell lymphoma. Leuk Lymphoma: 1–22

  2. Stiff P (2001) Mucositis associated with stem cell transplantation: current status and innovative approaches to management. Bone Marrow Transplant 27(Suppl 2):S3–S11

    Article  PubMed  Google Scholar 

  3. Pico JL, Avila-Garavito A (1998) Naccache et al. P. Mucositis: its occurrence, consequences, and treatment in the oncology setting. Oncologist 3:446–451

    PubMed  Google Scholar 

  4. Bey A, Ahmed SS, Hussain B, Devi S et al (2010) Prevention and management of antineoplastic therapy induced oral mucositis. Natl J Maxillofac Surg 1:127–134

    Article  PubMed Central  PubMed  Google Scholar 

  5. Sonis S, Clark J (1991) Prevention and management of oral mucositis induced by antineoplastic therapy. Oncology 5:11–18

    CAS  PubMed  Google Scholar 

  6. O’Brien SN, Blijlevens NM, Mahfouz TH et al (2003) Infections in patients with hematological cancer: recent developments. Hematol (Am Soc Hematol Educ Program) 2003:438–72

    Article  Google Scholar 

  7. Elting LS, Bodey GP, Keefe BH et al (1992) Septicemia and shock syndrome due to viridans streptococci: a case control study of predisposing factors. Clin Infect Dis 14:1201–1207

    Article  CAS  PubMed  Google Scholar 

  8. Spielberger R, Stiff P, Bensinger W et al (2004) Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med 351:2590–8

    Article  CAS  PubMed  Google Scholar 

  9. Lalla RV, Sonis SS, Peterson DE (2008) Management of oral mucositis in patients with cancer. Dent Clin North Am 52:61-viii

    Article  PubMed Central  Google Scholar 

  10. Vagliano L, Feraut C, Gobetto G et al (2011) Incidence and severity of oral mucositis in patients undergoing haematopoietic SCT—results of a multicentre study. Bone Marrow Transplant 46:727–32

    Article  CAS  PubMed  Google Scholar 

  11. Silverman S Jr (2007) Diagnosis and management of oral mucositis. J Support Oncol 5(Suppl 1):13–21

    CAS  PubMed  Google Scholar 

  12. Keefe DM, Schubert MM, Elting LS et al (2007) Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109:820–31

    Article  CAS  PubMed  Google Scholar 

  13. Sonis ST, Oster G, Fuchs H et al (2001) Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation. J Clin Oncol 19:2201–5

    CAS  PubMed  Google Scholar 

  14. Murphy BA (2007) Clinical and economic consequences of mucositis induced by chemotherapy and/or radiation therapy. J Support Oncol 5:13–21

    PubMed  Google Scholar 

  15. Nooka AK, Johnson HR, Kaufman JL, Flowers CR, Langston A, Steuer C et al (2014) Pharmacoeconomic analysis of palifermin to prevent mucositis among patients undergoing autologous hematopoietic stem cell transplantation. Biol Blood Marrow Transplant: J Am Soc Blood Marrow Transplant 20(6):852–7

    Article  CAS  Google Scholar 

  16. World Health Organization (1979) Handbook for reporting results of cancer treatment. Geneva, World Health Organization, pp 1–52

  17. Stiff PJ, Emmanouilides C, Bensinger WI et al (2006) Palifermin reduces patient-reported mouth and throat soreness and improves patient functioning in the hematopoietic stem-cell transplantation setting. J Clin Oncol 24:5186–93

    Article  CAS  PubMed  Google Scholar 

  18. Stiff PJ, Erder H, Bensinger WI et al (2006) Reliability and validity of a patient self-administered daily questionnaire to assess impact of oral mucositis (OM) on pain and daily functioning in patients undergoing autologous hematopoietic stem cell transplantation (HSCT). Bone Marrow Transplant 37:393–401

    Article  CAS  PubMed  Google Scholar 

  19. Webster K, Cella D, Yost K et al (2003) The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: applications, and interpretation. Health Qual Life Outcomes 1:79

    Article  PubMed Central  PubMed  Google Scholar 

  20. Machin D, Campbell MJ, Fayers PM et al (1997) Sample size tables for clinical studies, 2nd edn. Blackwell Science, Osney Mead, Oxford

    Google Scholar 

  21. Sonis ST, Elting LS, Keefe D et al (2004) Mucositis Study Section of the Multinational Association for Supportive Care in Cancer, International Society for Oral Oncology. Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer 100(Suppl 9):1995–2025

    Article  PubMed  Google Scholar 

  22. Vera-Llonch M, Oster G, Ford CM et al (2007) Oral mucositis and outcomes of autologous hematopoietic stem-cell transplantation following high-dose melphalan conditioning for multiple myeloma. J Support Oncol 5:231–235

    PubMed  Google Scholar 

  23. Vera-Llonch M, Oster G, Ford CM et al (2007) Oral mucositis and outcomes of allogeneic hematopoietic stem-cell transplantation in patients with hematologic malignancies. Support Care Cancer 15:491–496

    Article  PubMed  Google Scholar 

  24. Niscola P, Romani C, Cupelli L et al (2007) Mucositis in patients with hematologic malignancies: an overview. Hematologica 92:222–31

    Article  Google Scholar 

  25. Blijlevens N, Schwenkglenks M, Bacon P et al (2008) Prospective oral mucositis audit: oral mucositis in patients receiving high-dose melphalan or BEAM conditioning chemotherapy—European Blood and Marrow Transplantation Mucositis Advisory Group. J Clin Oncol 26:1519–25

    Article  CAS  PubMed  Google Scholar 

  26. Nasilowska-Adamska B, Rzepecki P, Manko J et al (2007) The influence of palifermin (Kepivance) on oral mucositis and acute graft versus host disease in patients with hematological diseases undergoing hematopoietic stem cell transplant. Bone Marrow Transplant 40:983–88

    Article  CAS  PubMed  Google Scholar 

  27. Sato A, Saisho-Hattori T, Koizumi Y et al (2006) Prophylaxis of mucosal toxicity by oral propantheline and cryotherapy in children with malignancies undergoing myeloablative chemo-radiotherapy. Tohoku J Exp Med 210:315–20

    Article  CAS  PubMed  Google Scholar 

  28. Vokurka S, Bystrická E, Koza V et al (2006) Higher incidence of chemotherapy induced oral mucositis in females: a supplement of multivariate analysis to a randomized multicentre study. Support Care Cancer 14:974–76

    Article  PubMed  Google Scholar 

  29. Vokurka S, Bystricka E, Scudlova J et al (2011) The risk factors for oral mucositis and the effect of cryotherapy in patients after the BEAM and HD-l-PAM 200 mg/m(2) autologous hematopoietic stem cell transplantation. Eur J Oncol Nurs 15:508–12

    Article  PubMed  Google Scholar 

  30. Grazziutti ML, Dong L, Miceli MH et al (2006) Oral mucositis in myeloma patients undergoing melphalan-based autologous stem cell transplantation: incidence, risk factors and a severity predictive model. Bone Marrow Transplant 38:501–06

    Article  CAS  PubMed  Google Scholar 

  31. Kim JW, Cha Y, Kim SJ et al (2012) Association of oral mucositis with quality of life and symptom clusters in patients with solid tumors receiving chemotherapy. Support Care Cancer 20:395–403

    Article  PubMed  Google Scholar 

  32. Goldberg SL, Chiang L, Selina N et al (2004) Patient perceptions about chemotherapy-induced oral mucositis: implications for primary/secondary prophylaxis strategies. Support Care Cancer 12:526–30

    Article  PubMed  Google Scholar 

  33. Cheng KK, Leung SF, Liang RH et al (2010) Severe oral mucositis associated with cancer therapy: impact on oral functional status and quality of life. Support Care Cancer 18:1477–85

    Article  PubMed  Google Scholar 

  34. Giesinger JM, Wintner LM, Zabernigg A et al (2014) Assessing quality of life on the day of chemotherapy administration underestimates patients’ true symptom burden. BMC Cancer 14:758

    Article  PubMed Central  PubMed  Google Scholar 

  35. Grulke N, Albani C (2012) Bailer Het al. Quality of life in patients before and after haematopoietic stem cell transplantation measured with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire QLQ-C30. Bone Marrow Transplant 47(4):473–82

    Article  CAS  PubMed  Google Scholar 

  36. Bevans MF, Mitchell SA, Barrett JA et al (2014) Symptom distress predicts long-term health and well-being in allogeneic stem cell transplantation survivors. Biol Blood Marrow Transplant 20(3):387–95

    Article  PubMed Central  PubMed  Google Scholar 

  37. Pillay B, Lee SJ, Katona L et al (2015) A prospective study of the relationship between sense of coherence, depression, anxiety, and quality of life of haematopoietic stem cell transplant patients over time. Psychooncology 24(2):220–7

    Article  PubMed  Google Scholar 

  38. Kav S, Aslan O, Tekin F et al (2009) Quality of life and difficulties of patients encountered after autologous stem cell transplantation. J BUON 14(4):673–80

    CAS  PubMed  Google Scholar 

  39. El-Jawahri AR, Traeger LN, Kuzmuk K et al (2015) Quality of life and mood of patients and family caregivers during hospitalization for hematopoietic stem cell transplantation. Cancer 121:951–9

    Article  PubMed  Google Scholar 

  40. Susan K (2013) Parsons, Hocine Tighiouart, and Norma Terrin. Assessment of health-related quality of life in pediatric hematopoietic stem cell transplant recipients: progress, challenges and future directions. Expert Rev Pharmacoecon Outcomes Res 13(2):217–225

    Article  Google Scholar 

  41. Pidala J, Anasetti C, Jim H et al (2010) Health-related quality of life following haematopoietic cell transplantation: patient education, evaluation and intervention. Br J Haematol 148(3):373–385

    Article  PubMed Central  PubMed  Google Scholar 

  42. Jim HS, Quinn GP (2014) Gwede CK et al Patient education in allogeneic hematopoietic cell transplant: what patients wish they had known about quality of life. Bone Marrow Transplant 49(2):299–303

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  43. Wang Y, Chen G, Qiao S et al (2011) Keratinocyte growth factor enhanced immune reconstitution in murine allogeneic umbilical cord blood cell transplant. Leuk Lymphoma 52(8):1556–66

    Article  CAS  PubMed  Google Scholar 

  44. Seggewiss R, Loré K, Guenaga FJ et al (2007) Keratinocyte growth factor augments immune reconstitution after autologous hematopoietic progenitor cell transplantation in rhesus macaques. Blood 110(1):441–9

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Steingrimsdottir H, Gruber A (2000) Björkholm M et al Immune reconstitution after autologous hematopoietic stem cell transplantation in relation to underlying disease, type of high-dose therapy and infectious complications. Haematologica 85(8):832–8

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This research project was supported by a grant from Genesis Pharma S.A.

Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Hematology Department and BMT Unit, “G. Papanicolaou” General Hospital of Thessaloniki, Exokhi, 57010, Thessaloniki, Greece

    Ioanna Sakellari & Achilles Anagnostopoulos

  2. “Laiko” General Hospital of Athens, Athens, Greece

    Maria Angelopoulou & Olga Tsopra

  3. “Attikon” University Hospital of Athens, Athens, Greece

    Ioannis Dervenoulas & Panagiotis Tsirigotis

  4. University General Hospital of Patras, Rio, Greece

    Alexandros Spyridonidis & Maria Liga

  5. 251 Airforce Millitary Hospital, Athens, Greece

    Konstantinos Tsionos & Konstantinos Anargyrou

  6. “Ag. Savvas” Peripheral Anticancer—Oncology Hospital, Athens, Greece

    Anastasia Pouli

Authors
  1. Ioanna Sakellari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Angelopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Olga Tsopra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ioannis Dervenoulas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Panagiotis Tsirigotis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexandros Spyridonidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maria Liga
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Konstantinos Tsionos
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Konstantinos Anargyrou
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Anastasia Pouli
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Achilles Anagnostopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ioanna Sakellari.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sakellari, I., Angelopoulou, M., Tsopra, O. et al. A prospective study of incidence, clinical and quality of life consequences of oral mucositis post palifermin prophylaxis in patients undergoing high-dose chemotherapy and autologous hematopoietic cell transplantation. Ann Hematol 94, 1733–1740 (2015). https://doi.org/10.1007/s00277-015-2437-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-015-2437-5

Keywords

Search

Navigation