Risk Factors For Oral Mucositis Research Articles

Clinical Risk Factors for High-Dose Methotrexate-Induced Oral Mucositis Following Individualized Dosing.

Oral mucositis affects about 20% of children undergoing high-dose methotrexate (HDMTX) for acute lymphoblastic leukemia (ALL), despite existing management strategies. Personalized HDMTX dosing, adjusted by pharmacokinetics and leukemia risk, has reduced mucositis incidence, but variations still occur with similar 24-h methotrexate levels. This retrospective study investigated risk factors for oral mucositis under individualized methotrexate protocols. Data from patients with ≥ Grade 2 oral mucositis (CTCAE v4.0) were analyzed from the St. Jude Children's Research Hospital total 16 trial. A 1:1 case-control matching method considered age, sex, risk classification, immunophenotype, and methotrexate course. McNemar's, Bowker's symmetry, and Wilcoxon signed-rank tests were used for statistical analyses. Risk factors for recurrent mucositis were identified in a case-only analysis. The study found significant associations between methotrexate-induced mucositis and new-onset skin rashes (p = 0.0027), fever (p = 0.0016), neutropenic fever (p = 0.0008), lower absolute neutrophil count (p < 0.0001), acute kidney injury (AKI) (p = 0.0164), delayed methotrexate clearance (p = 0.0133), and higher 42-h methotrexate levels (p = 0.0179). In the standard/high-risk group, mercaptopurine dose was also linked to mucositis (p = 0.0495). Multivariable analysis showed that skin rashes (OR 6.5, p = 0.0016), fever (OR 2.8, p = 0.009), and neutropenia (OR 2.3, p = 0.0106) were independent risk factors for mucositis. Female sex (OR 7.12, p = 0.015) and AKI (OR 3.819, p = 0.037) were associated with recurrent mucositis. Fever, skin rashes, AKI, delayed methotrexate clearance, and higher 42-h methotrexate levels were key risk factors for HDMTX-induced oral mucositis. Skin rashes, fever, and neutropenia were independent predictors, while female sex and AKI were linked to recurrent mucositis.

Oral Mucositis and Nutritional Status in Children Who Underwent Hematopoietic Cell Transplantation: AComparison Between Nonmalignant and Malignant Primary Diseases.

There is a lack of studies analyzing the association between oral mucositis (OM) and nutritional imbalance in children during hematopoietic stem cell transplantation (HSCT). The aim of this study was to compare the risk factors for OM and nutritional imbalance during HSCT in pediatric patients with nonmalignant diseases (NMD) and malignant diseases (MD). Data on age, sex, primary disease, transplantation type, conditioning regimen, GVHD prophylaxis, gastrointestinal toxicity, OM, percent body weight loss or gain, nutritional repositioning, and overall survival (OS) were retrospectively collected from the 132 medical records. The data were then compared between patients with NMD (n = 70) and MD (n = 62). OM had a similar severity between the groups. The primary risk factor for OM in the NMD group was the conditioning regimen with busulfan, while in the MD group it was GVHD prophylaxis with cyclosporin and methotrexate. OM did not have an impact on body weight loss or gain in any of the groups. In the NMD, body weight gain due to fluid overload was more pronounced and associated with a lower age range. OS was similar between the groups and was not affected by OM. OM pattern was similar in pediatric patients with or without MD, but the factors that determined these oral lesions were different. There were disparities in body weight changes between the two groups, and these changes were not associated to OM.

Risk factors for oral mucositis in patients with solid tumors under treatment with cetuximab: a retrospective cross-sectional study.

This study retrospectively analyzed the risk factors for oral mucositis (OM) during cetuximab treatment. We screened patients using cetuximab and retrospectively evaluated the presence of OM based on medical records. We collected information from 2 years of evaluations. Patient medical records were reviewed to obtain data on chemotherapy cycle and dose, sex, age, primary tumor, TNM stage, and head and neck radiotherapy (HNR) history. The X2 test and multinomial logistic regression were used for statistical analysis (SPSS 20.0, p < 0.05). Among 1831 patients, OM was showed in 750 in any grade (41%), during cetuximab treatment. Most patients were female (n=944, 51.6%), <70years-old (n=1149, 62.8%), had larynx cancer (n=789, 43.1%) in T4 (n=579, 47.7%), N0 (n=509, 52.6%) stages. Primary tumor surgery was performed in 1476 (80.6%) patients, radiotherapy in 606 (33.1%) patients and cetuximab protocols most used involved up to four cycles (n=1072, 58.5%) of <400mg (n=996, 54.4%) cetuximab doses. Female (OR [odds ratio] = 2.17, CI95% = 1.26-3.75), >70 years-old patients (OR = 16.02, CI95% = 11.99-21.41), with HHNR (OR = 1.84, 1.41-2.40), treated with >4 cycles (OR = 1.52, CI95% = 1.16-2.01) and high doses of cetuximab (OR = 3.80, CI95% = 2.52-5.71) are the greatest risk factors for OM. Since the clinical benefit of cetuximab in the treatment of older patients is limited and there is a high OM, especially in women with head and neck treated with radiotherapy, high doses and a high number of cetuximab cycles must be administered with caution.

Distribution and Drug Resistance of Pathogens in Oral Mucositis Associated with Chemotherapy in Patients with Malignant Hematopathy

To analyze the distribution and drug resistance of pathogens in oral mucositis associated with chemotherapy in hospitalized patients with malignant hematopathy, so as to provide scientific evidences for rational selection of antibiotics and infection prevention and control. From July 2020 to June 2022, 167 patients with malignant hematopathy were treated with chemical drugs in the Department of Hematology, Hainan Hospital, and secretions from oral mucosal infected wounds were collected. VITEK2 COMPECT automatic microbial identification system (BioMerieux, France) and bacterial susceptibility card (BioMerieux) were used for bacterial identification and drug susceptibility tests. A total of 352 strains of pathogens were isolated from 167 patients, among which 220 strains of Gram-positive bacteria, 118 strains of Gram-negative bacteria and 14 strains of fungi, accounted for 62.50%, 33.52% and 3.98%, respectively. The Gram-positive bacteria was mainly Staphylococcus and Streptococcus, while Gram-negative bacteria was mainly Klebsiella and Proteus. The resistance of main Gram-positive bacteria to vancomycin, ciprofloxacin and gentamicin was low, and the resistance to penicillin, cefuroxime, ampicillin, cefotaxime, erythromycin and levofloxacin was high. The main Gram-negative bacteria had low resistance to gentamicin, imipenem and penicillin, but high resistance to levofloxacin, cefotaxime, cefuroxime, ampicillin and vancomycin. The clinical data of oral mucositis patients with oral ulcer (severe) and without oral ulcer (mild) were compared, and it was found that there were statistically significant differences in poor oral hygiene, diabetes, sleep duration less than 8 hours per night between two groups (P<0.05). Gram-positive bacteria is the main pathogen of oral mucositis in patients with malignant hematopathy after chemotherapy. It is sensitive to glycopeptide antibiotics and aminoglycosides antibiotics. Poor oral hygiene, diabetes and sleep duration less than 8 hours per night are risk factors for oral mucositis with oral ulcer (severe).

&lt;strong&gt;Correlation analysis between risk factors and mucositis oral in head and neck cancer patients undergoing radiotherapy&lt;/strong&gt;

ABSTRACTIntroduction: Radiotherapy is a cancer therapy that uses ionizing radiation to damage cancer cells. Ionizing radiation in the head and neck area can disrupt the function and integrity of the oral mucosa and cause oral mucositis. In Bandung, the prevalence and risk factors of oral mucositis in head and neck cancer (HNC) patients undergoing radiotherapy have not been studied. Some textbooks claim that the prevalence of radiotherapy-induced oral mucositis in HNC patients occurs at almost 100%. Various risk factors associated with oral mucositis have been studied, giving significantly different results. This research analyzes the correlation between risk factors and mucositis oral in head and neck cancer patients undergoing radiotherapy. Methods: This research is a cross-sectional retrospective study with secondary data from medical records of HNC patients at RSHS from January 2015 until December 2019. A consecutive sampling method was used to collect the data that match the Inclusion criteria, including diagnosis of HNC(ICD-10), receiving radiotherapy from the first cycle until the last cycle; having a complete medical record following variables (location of HNC coding by ICD-10, gender, age, education level, smoking habit, the cycle of radiotherapy, oral treatment, body mass index, and comorbid disease). All data were then analyzed using Spearman correlation. Result: 171 medical records showed 59 patients had oral mucositis after radiotherapy. 26.9% male and 7.6% female, with susceptible age 40-60 years. Analysis of the Spearman correlation, there is a significant relationship between body mass index (BMI) (ρ = 0,001), smoking habits (ρ = 0,001), and radiotherapy cycles (ρ = 0.001). Conclusion: There is a correlation between risk factors of oral mucositis in HNC patients undergoing radiotherapy in RSHS, including body mass index (BMI), smoking habits, and radiotherapy cycles.Keywords: Head and neck cancer; oral mucositis; prevalence; risk factor; retrospective study

Incidence, severity, and onset of oral mucositis in 5-FU based chemotherapy for gastrointestinal cancer.

77 Background: 5-fluorouracil has been used in treatment of gastrointestinal cancers for more than 40 years. Numerous toxicities of 5-FU are known. Little is known about the occurrence, natural course and causes of oral mucositis (OM) of 5-FU in GI tumors. There is little data on the additional toxicity of VEGF and EGFR antibodies together with 5-FU. We followed the occurrence, severity and localization of OM of 5-FU in consecutive patients as part of their cancer treatment. The primary aim of the study was to determine the severity, course and risk factors of OM up to the first six cycles of ctx. OM was evaluated by repeated inspections of the oral cavity and patient questionnaires. Methods: Pts who received 5-FU for the first time or who had not received ctx for at least 12 months. 64 consecutive pts were included in the observational study from March 2018 to March 2019. Out of 64 pts a total of 41 (28 m/13f) had complete documentations (inspections of the oral cavity and questionnaires) and were available for the evaluation. Results: Mean age 65 ys (range 42-83), 60% were treated for CRC, 22% esophageal/gastric cancer, and 18% other GI-cancers. 13 were non-smokers, 25 former smokers; 7 pts had daily alcohol consumption while 7 pts never consumed alcohol. 10/41 pts wore a dental prosthesis. The mean BMI was 26.5 (range 18.8-41.5). Initial very good/ good oral hygiene was given in 3/20 patients. 80% of the pts developed xerostomia after the first cycle, almost every patient needed support for symptoms due to oral problems during ctx. Of 41 pts, an OM could be documented in 38 pts. A total of 93% of the patients developed a mild course of the mucositis with grade 1-2. OM developed between the 2nd and 3rd cyle in the majority of pts. At the third cyle, only 8 pts had OM of grade 0, while 23 pts had grade 1 and 9 pts were grade 2. It was of note here that of these 9 pts with grade 2, 6 had grade 0 in the 2nd cycle. During cycle 5 and 6 only seven pts had a CTC score of 0, but no pat developed a CTC 3 or 4 OM. We could not document a connection between the occurrence of oral mucositis and the oral hygiene measures used, as no severe course of OM CTC Grad 3 or 4 could be detected. We could not find any relation to the type of 5-FU therapy (doublet, triplet +/- monoclonal antibodies). Conclusions: The incidence of oral mucositis with CTC score of 1 and 2 was 93%, but serious grade 3 and 4 mucositis rates were not observed. Xerostomia was observed in 80% after the first course of treatment. Symptomatic mucositis occurs early within 4 weeks after starting chemotherapy. Local measures appear suitable for symptom control of OM.

Risk factors for oral mucositis during chemotherapy treatment for solid tumors: a retrospective STROBE-guided study.

Background This study retrospectively analyzed the risk factors for transchemotherapy oral mucositis (OM).Material and Methods Before each chemotherapy cycle, patients were routinely evaluated for the presence/severity of OM based on the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 scale for adverse effects and graded as follows: However, specific conditions such as mucositis are graded on a five-point scale: 0, absence of mucositis, grade 1 (Asymptomatic or mild), 2 (Presence of pain and moderate ulceration, without interference with food intake), 3 (severe pain with interference with food intake) or 4 (Life-threatening with the need for urgent intervention). Information from 2 years of evaluations was collected and patient medical records were reviewed to obtain data on chemotherapy cycle, sex, age, body mass index, body surface area, primary tumor, chemotherapy protocol, and history of head and neck radiotherapy. The X² test and multinomial logistic regression were used for statistical analysis (SPSS 20.0, p<0.05).Results Among 19,000 total evaluations of 3,529 patients during 5.32±4.7 chemotherapy cycles (CT) the prevalence of OM was 6.3% (n=1,195). Chemotherapy duration (p<0.001), female sex (p=0.001), adjuvant intention (p=0.008) and the use of carboplatin (p=0.001), cisplatin (p=0.029), docetaxel (p<0.001) and bevacizumab (p=0.026) independently increased the risk of mucositis. In head and neck tumors, 2018 year (p=0.017), chemotherapy duration (p=0.018), BMI>30 (p=0.008), radiotherapy (p=0.037) and use of carboplatin (p=0.046) and cyclophosphamide (p=0.010) increased this prevalence.Conclusions Cycles of chemotherapy, sex, cytotoxicity drugs, bevacizumab and head and neck radiotherapy increase the risk of OM in solid tumors. Key words:Mucositis, stomatitis, antineoplastic agentes, neoplasms, antineoplastic combined chemotherapy protocols.

Investigation of oral and general health status and IL-1β gene polymorphism as risk factors for oral mucositis in hematopoietic stem cell transplantation patients.

The aim of the present study was to analyze the relationship of OM with possible risk factors such as oral health condition, immunological status and IL-1β profile in patients submitted to hematopoietic stem cell transplantation (HSCT). Fifty-four individuals submitted to HSCT were included. All patients received previous dental treatment and photobiomodulation (PBM) as the institutional OM preventive protocol. OM scores, immune status, and IL-1β levels were determined during the conditioning period and at D+3 and D+8 after HSC infusion. IL-1β gene polymorphism was also analyzed during conditioning. Possible associations of OM with risk factors were analyzed using conditional Fisher's exact test. OM was observed in 34 patients (62.9%) classified as Grade 1 (13 patients/24.1%), Grade 2 (14 patients/25.9%), Grade 3 (3 patients/5.5%), and Grade 4 (4 patients/7.4%). Allogeneic HSCT individuals exhibited a higher OM grade than autologous subjects. Moreover, an association was observed between severe OM and severe gingivitis (p = 0.01), neutropenia (p = 0.03), and leukopenia (p = 0.04). A significant association between OM and lower IL-1β levels was detected at three time points, i.e., conditioning (p = 0.048), D+3 (p = 0.01), and D+8 (p = 0.005). The results showed that IL-1β gene polymorphism was not associated with OM. Our study provided important insights into the scope of OM risk factors in the setting of HSCT. Patients submitted to HSCT with severe gingivitis prior to chemotherapy and with severe neutropenia and leukopenia exhibited a higher OM grade. Further investigation will be necessary to better understand the exact role of IL-1β in the context of OM pathobiology and to validate cytokine analysis in larger cohorts.

Risk factors for oral mucositis in patients with malignant tumors: a prospective cohort study.

To investigate the incidence and risk factors of oral mucositis in patients with malignant tumors. A total of 74 patients with malignant tumors who were hospitalized in the Affiliated Hospital of Nantong University from January 2020 to December 2020 were selected and divided into two groups according to whether oral mucositis occurred (n=45) or not (n=29). Chi-square test was used to compare the general data between the two groups, and multivariate logistic regression analysis was used to investigate the risk factors of oral mucositis in patients with malignant tumors. Oral mucositis occurred in 45 of 74 malignant tumor patients (60.8%), and the incidence in patients with head and neck tumors was significantly higher than in those with chest and abdomen tumors (P<0.05). A significantly higher incidence was also seen in patients with poor oral cleanliness in comparison to those with high oral cleanliness; in radiotherapy patients in comparison to non-radiotherapy patients; in patients who received Nituzumab during radiotherapy in comparison to those who did not, and in patients receiving eight cycles of chemotherapy in comparison to those not receiving chemotherapy. Multivariate logistic regression analysis showed that oral cleanliness, radiotherapy, and duration of radiotherapy were independent risk factors for oral mucositis in patients with malignant tumors (P<0.05). Poor oral cleanliness, radiotherapy, and longer duration of radiotherapy lead to the occurrence of oral mucositis in patients with malignant tumors, and these risk factors should be targeted for intervention to reduce the occurrence of oral mucositis.

Determinants for Oral Mucositis in Allogeneic Hematopoietic Stem Cell Transplantation: Prospective Evaluation and Risk Analysis

Background: Oral mucositis (OM), secondary to mucosal barrier injury of pre-hematopoietic stem cell transplantation (HSCT) conditioning, is a common and painful toxicity of transplantation. Mucositis has been associated with increased risk for infections, hospitalization, analgesia and total parenteral nutrition use, and higher costs. However, prevalence and incidence data for mucositis are inconsistent and underreported. We set to prospectively identify risk factors for oral mucositis in patients undergoing allogeneic HSCT.Methods: OM was prospectively evaluated on a weekly basis in patients undergoing allogeneic HSCT. The grade of OM was determined based on the National Cancer Institute Common Toxicity Criteria for Adverse Events (CTCAE) scale (v. 4.0). Severe OM was defined as grade 2 or higher. Conditioning regimens were evaluated individually and according to intensity; myeloablative (MAC), reduced intensity (RIC) or reduced toxicity (RTC). The latter category included only patients receiving Fludarabine and Treosulfan (Flu/Treo). Variables associated with severe OM (p<0.05) were initially identified by univariate analysis (Chi-square and Mann Whitney U tests) and then analyzed in a multivariate logistic regression model. Cox and Fine and Gray regression models were used to study the association between severe OM and overall survival or nonrelapse mortality, respectively.Results: A total of 95 patients who underwent an allogeneic HSCT from 2016 to 2017 were included. Median age was 61 (range 19-75). Leading indications for HSCT were acute myeloid leukemia (51%), followed by myelodysplastic syndrome (15%), and non-Hodgkin lymphoma (12%). The majority of patients had a comorbidity score ≥3 (51%), were exposed to systemic antibiotics preceding transplantation (53%), and had no history of recent smoking (86.%). Donors were primarily HLA matched unrelated (51.1%) or HLA matched siblings (40%). RIC, MAC, and RTC regimens were used in 41%, 34%, and 25% of the patients, respectively. Methotrexate (MTX) (72.6%) or Mycophenolate mofetil (MMF) (27.4%), in conjunction with Cyclosporine, were given for graft versus host disease (GVHD) prophylaxis. Median follow-up was 165 days (95% CI 130-200).Median OM grade was 2 (range 0-4), with 65% of the patients experiencing severe mucositis. Median time from HSCT to OM and duration of OM were 8 days (1-14) and 10 days (2-40), respectively. Patients receiving Flu/Busulfan (Bu)-4 days (Flu/Bu4) were more likely to develop severe OM (91% vs. 9%, p<0.01), while among those conditioned with Flu/Treo, 29% had severe OM vs. 71% who did not (p<0.01) (Figure). In a univariate analysis, considering a broad range of patient, disease, and transplant characteristics (Table), only a history of recent smoking (19% vs. 3%, p=0.028), exposure to antibiotics in the preceding month pre-HSCT (61% vs. 39%, p=0.049), and use of MTX for GVHD prophylaxis (85% vs. 49., p<0.001) were associated with severe mucositis. Patients receiving RTC (i.e. Flu/Treo conditioning) had lower rates of severe OM compared to both RIC and MAC (p<0.001). Pre-HSCT albumin levels, obesity, and a low estimated glomerular filtration rate (eGFR) were not associated with OM. In a multivariate logistic regression model use of MTX vs. MMF had an increased risk for severe OM (odds ratio [OR] 11.6 [95% CI 3.2-42.4], p<0.001); compared to MAC, the risk for severe OM was reduced with RTC (OR 0.1 [0.0-0.4], p=0.001. OR for recent smoking was 6.8 (0.7-64.5), with a trend toward statistical significance (p=0.09). Severe OM was not associated with a decrease in short term overall survival (HR 0.59 [95% CI 0.2-1.5] or increase in non-relapse morality (HR 0.51 [0.1-2]).Conclusion: Our findings suggest that administration of Fludarabine and Treosulfan is an appealing option for conditioning since the risk for oral toxicity is low while intensity is high. Though having a borderline statistical significance, peri-transplantation smoking emerges as an important risk factor for oral mucositis. Therefore, patient counseling about smoking could potentially lower rates of mucositis. In contrast to previous reports, obesity and pre-HSCT albumin and reduced eGFR were not associated with mucositis in our cohort. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Incidence and risk factors for oral mucositis in pediatric patients receiving chemotherapy.

To investigate the incidence and risk factors for oral mucositis (OM) in patients with childhood cancer undergoing chemotherapy. Eight hundred and twenty-nine cycles of chemotherapy were evaluated in 112 patients with childhood cancer undergoing chemotherapy. Chemotherapy protocol, hematological, hepatic, and renal function parameters were collected and compared to presence and severity of OM, as graded by the World Health Organization (WHO) scale. Patients received counseling on oral hygiene and those who presented with OM (grade ≥1) received photobiomodulation therapy (PBMT). Age ranged from 0 to 17 years (mean/SD, 8.58 ± 5.05) and fifty-one patients (45.54%) were females. The most common baseline diseases were leukemia (51%) followed by sarcomas (23%) and lymphomas (18%). Eight hundred and twenty-nine cycles of chemotherapy were evaluated, and OM was diagnosed in 527 cycles (63.57%). Higher incidence and severity of OM was observed in protocols using high-dose methotrexate (MTX-HD), MTX-HD cyclophosphamide/doxorubicin combination, and MTX-HD combined with cyclophosphamide (p <0.001). Patients with severe OM had lower levels of leukocytes (p = 0.003), hemoglobin (p = 0.005), platelets (p = 0.034), and higher levels of total bilirubin (p = 0.027), alanine aminotransferase (ALT) (p = 0.001), and creatinine (p = 0.007). The study contributes to the elucidation of the risk factors for OM in pediatric cancer patients. Chemotherapy protocols using MTX-HD, MTX-HD associated with doxorubicin and cyclophosphamide, and MTX-HD and cyclophosphamide a have higher incidence of severe grades of OM. Other toxicities such as hematological, hepatic, and renal also developed in patients with OM.

Risk factors associated with the development of oral mucositis in pediatric oncology patients: Systematic review and meta-analysis.

Oral mucositis (OM) is an acute toxicity related to cancer treatment. This systematic review aimed to identify potential risk factors associated with the development of OM in pediatric cancer patients. A search was performed in four electronic databases to identify studies that analyzed risk factors for OM in pediatric cancer patients. Nineteen articles were included. The incidence of OM ranged from 20% to 80.4%. Chemotherapeutic agents were potential risk factors for OM in eight (42%) studies. Hematological, hepatic, and renal parameters were also considered in eight (42%) studies, while specific individual factors were reported in five (26.3%) studies. Baseline disease, oral microbiota, genetic profile, and biomarkers were reported in four (21.5%) studies each. Meta-analysis showed that groups submitted to high-risk chemotherapy for OM had a 2.79-fold increased risk of OM. Identifying risk factors for OM is essential in order to allow individualized and early prevention treatment.

Prevalence and risk factors of oral mucositis in paediatric patients undergoing haematopoietic stem cell transplantation

BackgroundA complete understanding of oral mucositis (OM) is crucial to develop appropriate interventions to aid in the successful overall health outcome of paediatric patients undergoing haematopoietic stem cell transplantation (HSCT).AimsThis study aimed at determining the prevalence and severity of OM and at identifying the predictive factors that might aggravate OM at one‐week, two‐week and three‐week post‐HSCT.MethodsThis retrospective, hospital‐based study reviewed the medical records of 170 paediatric patients, summarising the patients’ characteristics using descriptive statistics. Binary logistic regression was used to identify factors associated with the development of OM.ResultsAt one‐week post‐HSCT, 41% of 140 patients (n = 49) had developed OM, this was reduced at two‐week (n = 36, 33%) and three‐week (n = 13, 19%) post‐HSCT. Univariate logistic regression revealed that patients with cancer (OR = 0.16, 95% CI = 0.05–0.54; p‐value = .003) had a significantly lower prevalence of OM. Younger patients with an average age of 7.9 years old (OR = 0.85, 95% CI = 0.75–0.97; p‐value = 0.013) and the presence of GvHD (OR = 2.37, 95% CI = 1.03–5.45, p‐value = 0.042) were significantly related to a higher prevalence of OM. Multivariable logistic regression confirmed that the risk of OM is lower in patients with cancer compared to those with immunodeficiency syndromes or hereditary blood diseases (OR = 0.18, 95% CI = 0.04–0.77; p‐value = .021).ConclusionsThis study identified a significantly lower prevalence of OM in patients with cancer compared to other conditions and that young recipients and those who developed GvHD were more likely to have OM.

Oral mucositis in childhood cancer patients receiving high-dose methotrexate: Prevalence, relationship with other toxicities and methotrexate elimination.

Oral mucositis (OM) is one of the main adverse effects of the chemotherapeutic agent methotrexate (MTX). To evaluate the relationship of OM with MTX metabolism time and other toxicities in childhood, cancer patients receiving high-dose of methotrexate (HD-MTX). Seventy-seven childhood patients receiving HD-MTX for treatment of leukaemia, osteosarcoma or lymphoma were evaluated. MTX serum level, hepatic and renal function parameters, and presence and intensity of OM were analysed. The patients were submitted to 255 cycles of chemotherapy. OM was diagnosed in 191 (74.9%) cycles. Of these, 119 (46.6%) presented ulcerative lesions. Lymphoma was associated with severe OM (P=.01). OM was associated with higher serum levels of aspartate aminotransferase (P=.006), alanine aminotransferase (P=.04) and creatinine (P=.008). Increase of one unit of total bilirubin and indirect bilirubin associated, respectively, with 11% and 39% higher prevalence of OM. For each increase of one unit of creatinine serum level, it was observed a 37% higher prevalence of OM in patients with lymphoma. No association was found between delayed excretion of MTX and OM development. OM is a prevalent complication of childhood cancer patients receiving HD-MTX. Renal and hepatic toxicity could be considered risk factors for OM, especially in patients with lymphoma.

Prevalence and risk factors of oral mucositis in children with acute lymphoblastic leukemia in Dr. Soetomo Hospital Surabaya Indonesia

To examine the prevalence and risk factors of oral mucositis in children with acute lymphoblastic leukemia in Dr. Soetomo Hospital Surabaya, Indonesia. This study was a case-control study with frequency distribution design, describes the incidence of oral mucositis in children suffering from acute lymphoblastic leukemia who underwent chemotherapy in RSUD Dr. Soetomo. The sampling technique used was consecutive non-random sampling. In this study, the incidence of mucositis was not differentiated based on the type of chemotherapy received by the patient. Based on the results of the study, the incidence of oral mucositis was found in 18.2% of all children in the Inpatient Installation of Children (IRNA) oncology ward Hematology, Department of Pediatrics, Dr. Soetomo Surabaya with male gender characteristics (63.6%), in the group age of 5-6 years (21%) with malnutrition status (50%). The results of this study provided information about risk factors for oral mucositis in children with acute lymphoblastic leukemia and to prevent oral mucositis by reducing the risk factors that trigger oral mucositis in acute lymphoblastic leukemia.

Risk factors of oral mucositis and oral candidiasis in patients with oral or oropharyngeal cancer undergoing radiotherapy: Results of a multicenter study of 326 patients

Risk factors of oral mucositis and oral candidiasis in patients with oral or oropharyngeal cancer undergoing radiotherapy: Results of a multicenter study of 326 patients

Incidence of and risk factors for development of oral mucositis in outpatients undergoing cancer chemotherapy.

The aims of the study are to determine the incidence of oral mucositis, the stage of the condition, risk factors, and other oral complications in patients receiving outpatient chemotherapy and to evaluate the factors that have an impact on these. The study included 147 patients undergoing outpatient cancer chemotherapy at the Chemotherapy Unit of a University Hospital between February and April 2015. We used a questionnaire and the World Health Organization "Mucositis Grading Scale". Chi-squared tests were used to determine the relationships between factors, and multiple logistic regression analysis was employed to explore predictive factors. The frequency of oral mucositis was 51.7%. The most common oral problems were mouth dryness (55.1%), a reduced/changed sense of taste (52.4%), and a lack of appetite (47.6%). Logistic regression analysis showed that the risk factors for oral mucositis were advanced age, a lack of appetite, and the duration of chemotherapy. As a result, half of all patients undergoing outpatient cancer chemotherapy developed oral mucositis. Patients are unable to adequately prevent oral mucositis and carry out oral care. It is recommended that more studies be conducted in outpatient units to evaluate predictive factors for oral mucositis.

The Prevalence and Investigation of Risk Factors of Oral Mucositis in a Pediatric Oncology Inpatient Population; a Prospective Study.

Oral mucositis can be a frequent and severe complication of chemotherapy in children. It can result in pain, infection, depression, prolonged admission, treatment delays, increase in patient morbidity, and increased costs. To record the prevalence and severity of oral mucositis among inpatients and explore the relationship of risks factors and the development of oral mucositis. During an 18-month period 643 clinical inpatient assessments were completed on 73 children who were admitted and had received chemotherapy in the last 14 days. There were 43 episodes of oral mucositis in 31 children; 42.5% of the inpatient population. World Health Organization assessment identified 32.6% of episodes were grade 1, 34.9% grade 2, 14.0% grade 3, and 18.6% grade 4. Analysis revealed significant associations between patient diagnosis (P<0.0001), chemotherapy cycles (P<0.0001), day 8 and 9 of the chemotherapy cycle (P<0.05), and neutropenia (P<0.0001) and oral mucositis. Children had increased length of admission with increasing severity of oral mucositis (P=0.0005). The prevalence of oral mucositis was 42.5% among inpatients and admission length was increased with increasing severity. Patient diagnosis, chemotherapy treatment block, day of chemotherapy cycle, and neutropenic status were shown to influence the risk of developing oral mucositis.

New photobiomodulation protocol prevents oral mucositis in hematopoietic stem cell transplantation recipients-a retrospective study.

Oral mucositis (OM) is an adverse side effect among hematopoietic stem cell transplantation (HSCT) recipients. The objective of this retrospective study was to evaluate the preventive effect of photobiomodulation (PBM) applied three times per week versus seven times per week in patients undergoing HSCT. The risk factors related to the incidence and severity of OM were also assessed. This was a retrospective study that evaluated 99 HSCT recipients who received different PBM protocols. Group I received three sessions per week, and group II received daily treatment. PBM was applied using a continuous-wave diode laser (InGaAlP; MM Optics, São Carlos, SP, Brazil) at a wavelength of 660nm (visible-red) and a total radiant energy of 0.24J per point. The baseline disease, type of transplant, type of conditioning, prophylaxis against graft-versus-host disease, OM grade, absolute leukocyte and platelet counts, and levels of liver and renal function markers were collected from medical records. The patients' age ranged from 13 to 71years (mean/SD, 40.54±16.45). No significant difference was observed between groups I and II regarding sex, age, ethnic, diagnosis, donor type, and conditioning treatment. Both PBM protocols were equally efficient in preventing OM (p=0.34, ANOVA). Independent of the PBM protocol used, patients who received allogeneic transplant (p<0.01-Fischer's exact test), total body irradiation (TBI-12Gy) (p=0.01-chi-square test), busulfan + cyclophosphamide (p<0.01-chi-square test), or methotrexate-containing regimens (p<0.01-Fischer's exact test) demonstrated higher OM incidence and severity. Myelosuppression (p<0.01-Mann-Whitney test) and impaired renal function (p=0.02-Mann-Whitney test) were also considered risk factors for OM. Based on this retrospective data, PBM was effective in preventing OM in patients undergoing HSCT even when it was applied three times a week. A prospective study might be necessary to confirm these findings.

Variability of high-dose melphalan exposure on oral mucositis in patients undergoing prophylactic low-level laser therapy.

The present study outlines the clinical impact and risk factors of oral mucositis in 79 patients with multiple myeloma following high-dose melphalan for autologous transplant. All patients underwent daily prophylactic low-level indium gallium aluminum phosphate diode laser therapy (660nm, 15mW, 3.75J/cm2, 10s per point) from the beginning of the conditioning regimen up to day +2. Oral mucositis assessments were made daily until hospital discharge. For analysis, oral mucositis was divided into two groups according to severity: group 1, patients with oral mucositis grade <III (n=71) and group 2, patients with oral mucositis grade ≥III (n=8). Univariate logistic models were used to determine the risk factors. Patients in group 1 were found to have statistically fewer days of oral pain than those in group 2 (3.94 and 6.25days, respectively, p=0.014). Morphine was required in 75% of patients in group 2, versus 42.25% in group 1 (p=0.06). Risk of severe oral mucositis was associated with higher serum creatinine levels (OR=6.10; 95% CI 1.25-31.60; p=0.02) and older age (OR=1.21; 95% CI 1.05-1.47; p=0.027). Severe oral mucositis was associated with worse clinical outcomes. Older patients and those with renal dysfunction previous autologous transplant had the greatest risk for severe oral mucositis despite prophylactic laser treatment. Our results highlight the importance of further research to define the dose, application time, and number of prophylactic laser sessions in those patients with the greatest risk for severe oral mucositis.