30/6/2017
MINIMIZING THE RISK OF MUCOSITIS IN HEMATOLOGIC PATIENTS WITH.... EHA Learning Center. Ursuleac I. May 18 2017; 182842
Iulia Ursuleac
Abstract
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Background
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Mucositis is a frequent severe complication associated to aggressive therapies of hematological malignancies
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with chemo and/or radiation (therapy), conditioning therapy in stem cell transplants. Regularly occurs at 3 to
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in this period the patient is vulnerable to systemic infections (bacterial and fungal). It could also compromise
membership benefit.
the optimal timing and dosage of the chemotherapy schedule, induce psychosocial distress, prolonged
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hospitalization and finally, higher costs.
10 days after chemotherapy and about 6 to 8 weeks after radiotherapy. It is self-limited within 2-4 weeks, but
Aims
    
Evaluating the efficacy of Gel X® in chemotherapy induced mucositis. GelX® is a topical product that
contains Zinc gluconate + taurine, with bacteriostatic and anti-inflammatory effect, easy to use for the patient,
in order to prevent and reduce pain and severity of oral ulcers, making a barrier for mucosae
Methods
A retrospective analysis of 77 adult patients: 17 with hematological treatments and 60 with allogeneic stem
cell transplantation. 17 were diagnosed and treated between January 2015 and December 2016 with various
hematologic malignances (5 AML, 2 ALL – 1 Ph positive, 2 blastic phases of CML, 3 AILT (CHOP/DAEPOCH), 2 DLBCL (RCHOP), 1 FL (RCVP), 1 MM (radiotherapy), 1Hodgkin disease (ABVD). Treatment
regimens used for acute leukemias/blastic phases of CML were: “3+7” (3 cases), MEC (1 case), high doses
ARA-C (1), GMALL protocol (1), HyperCVAD (1), Idarubicine and ARA-C(1) HD-MTX(1) . GelX® was
indicated as prophylactic treatment for eight patients, because the risk of mucositis was high (aggressive
chemotherapy, bad oral condition, risk of prolonged neutropenia). Curative treatment of grade 3-4 mucositis
was indicated for 10 patients (one was initially treated with curative intention and after that with prophylaxis).
In 60 patients allografted for various hematological conditions (35 unrelated, 4 haplo and 21 sibling) GelX®
was prescribed for treating grade 3-4 mucositis. For the 35 cases with unrelated allotransplant (21 AML, 4
ALL, 2 SA, 2ATLL, 2 MMM, 2 CML, 1 MDS, 1 BH), 16 cases of grade 3-4 mucositis has appeared .The
conditioning regimen was mieloablative(14 cases) and reduced intensity( 21 cases) .There were 21 cases of
sibling allotransplants (6AML, 3 ALL, 1 ATLL, 5 LMNH, 1CLL, 2 SAA, 2 CML, 1 mycosis)with 10 cases of
mucositis grade 3-4. The regimens used were 6 mieloablative and 15 nonmieloablative. 3 from 4 cases of
haplotransplant with nonmieloablative conditioning (2MDS, 1 AML and 1 SAA) had grade 3 mucositis.
Results
Prophylactic treatment induced a reduction in the grading of mucositis (grad 1-2) and a shorter period of
evolution (5 days) versus grade 3-4 mucositis and prolonged duration of oral lesions for those with curative
treatment. From 60 patients allotransplanted, 30 patients experienced grade 3 and 4 mucositis with a medium
duration of five days. All of them received GelX® as prophylactic treatment.
Conclusion
Prophylaxis is the key of successful evolution in mucositis (time to heal shorter than 10 days). Identifying
candidates for mucositis is mandatory and the product should be applied starting with the chemotherapy (or
in the first 24 hours on the onset of chemotherapy) in order to minimize the risk of mucositis appearance.
Session topic: 35. Quality of life, palliative care, ethics and health economics
Keyword(s): Treatment, Mucositis, Hematological malignancy
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