Abstract
ObjectivesControversy exists regarding whether oral cryotherapy can prevent oral mucositis (OM) in patients with hematological malignancies undergoing hematopoietic stem cell transplantation (HSCT). The aim of the present meta-analysis was to evaluate the efficacy of oral cryotherapy for OM prevention in patients with hematological malignancies undergoing HSCT.MethodsPubMed and the Cochrane Library were searched through October 2014. Randomized controlled trials (RCTs) comparing the effect of oral cryotherapy with no treatment or with other interventions for OM in patients undergoing HSCT were included. The primary outcomes were the incidence, severity, and duration of OM. The secondary outcomes included length of analgesic use, total parenteral nutrition (TPN) use, and length of hospital stay.ResultsSeven RCTs involving eight articles analyzing 458 patients were included. Oral cryotherapy significantly decreased the incidence of severe OM (RR = 0.52, 95% CI = 0.27 to 0.99) and OM severity (SMD = -2.07, 95% CI = -3.90 to -0.25). In addition, the duration of TPN use and the length of hospitalization were markedly reduced (SMD = -0.56, 95% CI = -0.92 to -0.19; SMD = -0.44, 95% CI = -0.76 to -0.13; respectively). However, the pooled results were uncertain for the duration of OM and analgesic use (SMD = -0.13, 95% CI = -0.41 to 0.15; SMD = -1.15, 95% CI = -2.57 to 0.27; respectively).ConclusionsOral cryotherapy is a readily applicable and cost-effective prophylaxis for OM in patients undergoing HSCT.
Highlights
Hematopoietic stem cell transplantation (HSCT) is a curative treatment for most hematological malignancies [1, 2]
Oral cryotherapy significantly decreased the incidence of severe Oral mucositis (OM) (RR = 0.52, 95% confidence interval (CI) = 0.27 to 0.99) and OM severity (SMD = -2.07, 95% CI = -3.90 to -0.25)
Oral cryotherapy significantly decreased the incidence of severe OM (RR = 0.52, 95% CI = 0.27 to 0.99; I2 = 66.1%, p = 0.011; Fig 2)
Summary
Hematopoietic stem cell transplantation (HSCT) is a curative treatment for most hematological malignancies [1, 2]. Oral mucositis (OM), which is characterized by inflammatory and ulcerative reactions in the oral cavity [3], often results from the cytotoxic effects of chemotherapy on the epithelial cells of the oral mucosa [4]. OM is a severe and debilitating complication that is frequently encountered after HSCT. It occurs in approximately 80% of patients who receive high-dose chemotherapy as conditioning for HSCT [5], with conditioning regimens containing high-dose melphalan. Graft-versus-host disease (GVHD) prophylaxis that includes methotrexate (MTX) has been associated with an increased incidence of OM [2, 6]. OM dramatically impairs the quality of life of patients and increases hospital costs [2, 4]
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