Efficacy of mouth rinse in preventing oral mucositis in patients receiving high-dose cytarabine for allogeneic hematopoietic stem cell transplantation.
High-dose cytarabine is one of the major components of the conditioning regimen for hematopoietic stem cell transplantation (HSCT), and frequently causes severe oral mucositis. We have recently demonstrated that cytarabine is excreted into the saliva in patients receiving high-dose cytarabine, and proposed that it might locally and directly contribute to the development of oral mucositis. Therefore, this study was performed to assess whether removing the excreted cytarabine in the saliva by intensive mouth rinse during high-dose cytarabine infusion could reduce the incidence of oral mucositis. Fifteen patients with hematologic malignancies undergoing allogeneic HSCT who received total body irradiation (12 Gy) and high-dose cytarabine at a dose of 3 g/m(2) every 12 h for 4 days as a conditioning were evaluated. Patients were instructed to rinse their mouths using ice-cold water every 10 min, starting simultaneously with the 2-h cytarabine infusion and continuing up to 1 h after completion of each infusion. Oral mucositis was graded on a daily basis according to the National Cancer Institute, Common Toxicity Criteria. Thirty-five patients who previously underwent the same conditioning without mouth rinse served as controls. The incidence of Grades 2-3 and Grade 3 oral mucositis was significantly reduced in patients who performed mouth rinse as compared with the controls (40 vs. 80%, P = 0.009; 0 vs. 25. 7%, P = 0.02). In conclusion, mouth rinse during and shortly after high-dose cytarabine infusion could be an effective and inexpensive measure in reducing the incidence of moderate to severe oral mucositis caused by high-dose cytarabine. This finding strongly suggests the role of cytarabine excretion in the saliva in the development of cytarabine-associated oral mucositis.
Mori
Takehiko
T
Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. tmori@sc.itc.keio.ac.jp.|Novartis Pharma Program for Clinical Therapeutics of Hematologic Malignancy, Keio University School of Medicine, Tokyo, Japan. tmori@sc.itc.keio.ac.jp.
Hasegawa
Kaori
K
Department of Nursing, Keio University Hospital, Tokyo, Japan.
Okabe
Ai
A
Department of Nursing, Keio University Hospital, Tokyo, Japan.
Tsujimura
Natsuki
N
Department of Nursing, Keio University Hospital, Tokyo, Japan.
Kawata
Yusuke
Y
Department of Nursing, Keio University Hospital, Tokyo, Japan.
Yashima
Tomoko
T
Department of Nursing, Keio University Hospital, Tokyo, Japan.
Kobayashi
Naoko
N
Department of Nursing, Keio University Hospital, Tokyo, Japan.
Kondo
Sakiko
S
Department of Nursing, Keio University Hospital, Tokyo, Japan.
Aisa
Yoshinobu
Y
Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Kato
Jun
J
Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.|Novartis Pharma Program for Clinical Therapeutics of Hematologic Malignancy, Keio University School of Medicine, Tokyo, Japan.
Tsunoda
Kazuyuki
K
Department of Dentistry and Oral Surgery, Keio University School of Medicine, Tokyo, Japan.
Nagai
Tetsuo
T
Department of Dentistry and Oral Surgery, Keio University School of Medicine, Tokyo, Japan.
Nakagawa
Taneaki
T
Department of Dentistry and Oral Surgery, Keio University School of Medicine, Tokyo, Japan.
Shigematsu
Naoyuki
N
Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
Kubo
Atsushi
A
Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
Ikeda
Yasuo
Y
Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Okamoto
Shinichiro
S
Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
D000328:Adult; D003561:Cytarabine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene; D013280:Stomatitis / Q000139:chemically induced / Q000517:prevention & control*; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation
D007166:Immunosuppressive Agents; D003561:Cytarabine