title: The choice of multiple myeloma induction therapy affects the frequency and severity of oral mucositis after melphalan-based autologous stem cell transplantation.
abstract: BACKGROUND
  Mucositis is a common complication of high-dose melphalan (HDM) used before autologous stem cell transplantation (ASCT) for multiple myeloma (MM). Mucositis rates are influenced by previous chemotherapy (CT) exposure. We examined the effect of induction therapy before ASCT on ASCT mucositis rates.
  
  
  METHODS
  Patients undergoing first 200 mg/m(2) HDM ASCT were assessed. Those receiving < 200 mg/m(2), or those with previous ASCT were excluded. Patients were evaluated depending on type of induction therapy (CT, immunomodulatory drug [IMiD], or proteasome inhibitor [PI]) before ASCT. A case record review was performed and data collected on response to induction, rates of Grade 3/4 mucositis, and days of total parenteral nutrition (TPN) or parenteral opiate analgesia.
  
  
  RESULTS
  One hundred twenty-eight patients with ASCT were assessed. Induction therapy was CT- (n = 62), IMiD- (n = 51), or PI-based (n = 15) therapy. Patient characteristics were overall similar, including median age, MM stage, and CD34(+) cell dose. IMiD-based therapy patients had lower rates of mucositis (33% vs. 53%; P = .03) and less opiate requirements (10% vs. 31%; P = .02) compared with those treated with CT. Rates of mucositis and opiate use in the PI group were not different to the CT cohorts (33% vs. 53%; P = .6 and 13% vs. 31%; P = .13), likely due to concurrent anthracycline exposure. TPN usage was similar (CT, 42%; IMiD, 35%; and PI, 20%), as was neutropenia duration and antibiotic usage.
  
  
  CONCLUSIONS
  Patients treated with IMiD-based regimens before HDM ASCT had significantly lower rates of mucositis than those treated with CT-based therapy. There were too few patients who received PI therapy to evaluate the effect.
authors.affiliation: The Royal Melbourne Hospital, Victoria, Australia. Electronic address: flemsha@gmail.com.
authors.forename: Shaun
authors.initials: S
authors.lastname: Fleming
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Victoria, Australia.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Harrison
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Piers
authors.initials: P
authors.lastname: Blombery
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Trish
authors.initials: T
authors.lastname: Joyce
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Kerrie
authors.initials: K
authors.lastname: Stokes
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Victoria, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Seymour
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Victoria, Australia.
authors.forename: H Miles
authors.initials: HM
authors.lastname: Prince
authors.affiliation: The Royal Melbourne Hospital, Victoria, Australia; Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Ritchie
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D009367:Neoplasm Staging; D012720:Severity of Illness Index; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects; D013280:Stomatitis / Q000175:diagnosis / Q000209:etiology*; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D013256:Steroids; D008558:Melphalan
keywords: Autologus transplantation; Mucositis; Myeloma; Novel therapy; Supportive Care