Abstract
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 with hematologic malignancies 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 281 AL HSCT recipients in the study cohort.
Results. Mean age was 41 yrs. Most common diagnoses were acute (33%) and chronic (19%) myeloid leukemia. Most patients (96%) received total body irradiation. Fifty-one percent of grafts were from unrelated donors. Seventy-six 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 patients with hematologic malignancies undergoing AL HSCT.
Outcomes of AL HSCT in patients with hematologic malignancies, by worst recorded grade of OM
| . | Worst Grade of OM (N=281) . | ||||||
|---|---|---|---|---|---|---|---|
| . | 0 . | I . | II . | III . | IV . | V . | . |
| Outcome . | n=34 . | n=33 . | n=70 . | n=60 . | n=43 . | n=41 . | -value p . |
| *mean, SD; **test for linear trend; Cochran-Armitage for dichotomous measures, GLM for continuous measures | |||||||
| Fever days* | 3.1 (3.0) | 4.8 (4.4) | 5.3 (4.9) | 5.7 (4.7) | 5.9 (4.7) | 7.3 (4.6) | <0.001 |
| TPN days* | 6.7 (7.2) | 7.7 (7.8) | 8.8 (7.8) | 10.2 (7.8) | 13.2 (7.2) | 14.0 (6.2) | <0.001 |
| Narcotic days* | 7.6 (6.3) | 10.8 (5.0) | 10.7 (7.4) | 11.5 (5.1) | 14.0 (6.8) | 17.2 (5.0) | <0.001 |
| Infection (%) | 85.3 | 90.9 | 92.9 | 93.3 | 100.0 | 100.0 | 0.002 |
| Mortality (%) | 8.8 | 3.0 | 8.6 | 15.0 | 7.0 | 22.0 | 0.042 |
| Inpatient days* | 28.1 (8.8) | 30.3 (10.6) | 34.5 (15.1) | 32.7 (14.5) | 35.9 (10.4) | 42.4 (15.1) | <0.001 |
| Inpatient charges* (x 1,000 USD) | 214 (102) | 252 (156) | 313 (251) | 280 (198) | 305 (140) | 437 (233) | <0.001 |
| . | Worst Grade of OM (N=281) . | ||||||
|---|---|---|---|---|---|---|---|
| . | 0 . | I . | II . | III . | IV . | V . | . |
| Outcome . | n=34 . | n=33 . | n=70 . | n=60 . | n=43 . | n=41 . | -value p . |
| *mean, SD; **test for linear trend; Cochran-Armitage for dichotomous measures, GLM for continuous measures | |||||||
| Fever days* | 3.1 (3.0) | 4.8 (4.4) | 5.3 (4.9) | 5.7 (4.7) | 5.9 (4.7) | 7.3 (4.6) | <0.001 |
| TPN days* | 6.7 (7.2) | 7.7 (7.8) | 8.8 (7.8) | 10.2 (7.8) | 13.2 (7.2) | 14.0 (6.2) | <0.001 |
| Narcotic days* | 7.6 (6.3) | 10.8 (5.0) | 10.7 (7.4) | 11.5 (5.1) | 14.0 (6.8) | 17.2 (5.0) | <0.001 |
| Infection (%) | 85.3 | 90.9 | 92.9 | 93.3 | 100.0 | 100.0 | 0.002 |
| Mortality (%) | 8.8 | 3.0 | 8.6 | 15.0 | 7.0 | 22.0 | 0.042 |
| Inpatient days* | 28.1 (8.8) | 30.3 (10.6) | 34.5 (15.1) | 32.7 (14.5) | 35.9 (10.4) | 42.4 (15.1) | <0.001 |
| Inpatient charges* (x 1,000 USD) | 214 (102) | 252 (156) | 313 (251) | 280 (198) | 305 (140) | 437 (233) | <0.001 |
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