Background. OM is a common toxicity of conditioning regimens for HSCT that has been associated with adverse clinical and economic outcomes.

Methods. A retrospective chart review study of ~400 consecutive HSCT recipients was undertaken at a single academic center. OM severity was assessed across eight oropharyngeal sites using a validated scale which was scored as follows: no erythema/ulceration = 0; erythema only = I; ulceration one site = II; two sites = III; three sites= IV; and four or more sites = V. OM assessments began on the day of conditioning and continued bi-weekly until hospital discharge. Outcomes of interest included number of days of fever, total parenteral nutrition (TPN), and parenteral narcotic therapy, incidence of grade III or IV (Common Toxicity Criteria) infection, and inpatient days and charges. We report data here for the 115 MM patients in the study cohort who underwent AU HSCT after high-dose MP conditioning.

Results. Mean age was 54 yrs. Seventeen percent of patients received total body irradiation. Bone marrow was the source of most grafts. Forty-eight percent of patients experienced OM ≥ grade II. The relationship between worst recorded grade of OM and each of the outcomes of interest is reported below.

Conclusions. OM is associated with worse clinical and economic outcomes in MM patients undergoing AU HSCT following high-dose MP conditioning.

Outcomes of AU HSCT following high-dose MP conditioning for MM, by worst recorded grade of OM

Worst Grade of OM (N=115)
0IIIIIIIVV
*mean, SD; **test for linear trend; Cochran-Armitage for dichotomous measures, GLM for continuous measures 
Outcome n=37 n=23 n=24 n=15 n=8 n=8 -value p 
Fever days* 1.2 (2.8) 2.5 (3.1) 2.1 (2.3) 1.9 (1.4) 3.0 (2.1) 3.6 (6.2) 0.057 
TPN days* 0.0 (0.0) 0.1 (0.4) 0.0 (0.0) 0.0 (0.0) 0.0 (0.0) 2.3 (6.0) 0.003 
Narcotic days* 1.5 (3.1) 4.7 (3.8) 4.6 (4.4) 4.4 (3.7) 7.9 (3.3) 9.9 (7.4) <0.001 
Infection, % 51.4 73.9 62.5 80.0 100.0 75.0 0.014 
Mortality, % 0.0 0.0 4.2 0.0 0.0 12.5 0.085 
Inpatient days* 18.6 (3.4) 21.0 (3.5) 19.6 (3.6) 19.7 (2.3) 23.3 (2.4) 23.4 (5.6) <0.001 
Inpatient charges* (x 1,000 USD) 119 (36) 130 (35) 118 (25) 121 (28) 141 (31) 184 (92) <0.001 
Worst Grade of OM (N=115)
0IIIIIIIVV
*mean, SD; **test for linear trend; Cochran-Armitage for dichotomous measures, GLM for continuous measures 
Outcome n=37 n=23 n=24 n=15 n=8 n=8 -value p 
Fever days* 1.2 (2.8) 2.5 (3.1) 2.1 (2.3) 1.9 (1.4) 3.0 (2.1) 3.6 (6.2) 0.057 
TPN days* 0.0 (0.0) 0.1 (0.4) 0.0 (0.0) 0.0 (0.0) 0.0 (0.0) 2.3 (6.0) 0.003 
Narcotic days* 1.5 (3.1) 4.7 (3.8) 4.6 (4.4) 4.4 (3.7) 7.9 (3.3) 9.9 (7.4) <0.001 
Infection, % 51.4 73.9 62.5 80.0 100.0 75.0 0.014 
Mortality, % 0.0 0.0 4.2 0.0 0.0 12.5 0.085 
Inpatient days* 18.6 (3.4) 21.0 (3.5) 19.6 (3.6) 19.7 (2.3) 23.3 (2.4) 23.4 (5.6) <0.001 
Inpatient charges* (x 1,000 USD) 119 (36) 130 (35) 118 (25) 121 (28) 141 (31) 184 (92) <0.001 
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Topics:
conditioning (psychology), hematopoietic stem cell transplantation, melphalan, multiple myeloma, oropharyngeal mucositis, erythema, fever, infections, narcotics, toxic effect

Author notes

Corresponding author

2005, The American Society of Hematology
2005
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