title: Icing oral mucositis: Oral cryotherapy in multiple myeloma patients undergoing autologous hematopoietic stem cell transplant.
abstract: Background Up to 70% of patients receiving hematopoietic stem cell transplant develop oral mucositis as a side effect of high-dose melphalan conditioning chemotherapy. Oral cryotherapy has been documented to be potentially effective in reducing oral mucositis. The aim of this study was to examine the effectiveness of the cryotherapy protocol implemented within the hematopoietic stem cell transplant program. Methods A retrospective chart review was conducted of adult multiple myeloma patients who received high-dose melphalan conditioning therapy for autologous hematopoietic stem cell transplant. Primary endpoints were incidence and severity of oral mucositis. Secondary endpoints included duration of oral mucositis, duration of hospital stay, parenteral narcotics use and total parenteral nutrition use. Results One hundred and forty patients were included in the study, 70 patients in both no cryotherapy and cryotherapy groups. Both oral mucositis incidence and severity were found to be significantly lower in the cryotherapy group. Fifty (71.4%) experienced mucositis post cryotherapy compared to 67 (95.7%) in the no cryotherapy group (p < 0.001). The median oral mucositis severity, assessed using the WHO oral toxicity scale from grade 0-4, experienced in the no group was 2.5 vs. 2 in the cryotherapy group (p = 0.03). Oral mucositis duration and use of parenteral narcotics were also significantly reduced. Duration of hospital stay and use of parenteral nutrition were similar between the two groups. Conclusion The cryotherapy protocol resulted in a significantly lower incidence and severity of oral mucositis. These results provide evidence for the continued use of oral cryotherapy, an inexpensive and generally well-tolerated practice.
authors.affiliation: 1 Department of Pharmacy, Alberta Health Services, Alberta, Canada.
authors.forename: Joey
authors.initials: J
authors.lastname: Chen
authors.affiliation: 2 Department of Paediatrics, London Health Sciences Center, Ontario, Canada.
authors.forename: Jamie
authors.initials: J
authors.lastname: Seabrook
authors.affiliation: 3 Department of Hematology/Oncology, London Health Sciences Center, Ontario, Canada.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Fulford
authors.affiliation: 4 Department of Pharmacy, London Health Sciences Center, Ontario, Canada.
authors.forename: Irina
authors.initials: I
authors.lastname: Rajakumar
mesh_terms: D017679:Cryotherapy / Q000009:adverse effects / Q000191:economics; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D007263:Infusions, Parenteral; D007902:Length of Stay; D008297:Male; D008558:Melphalan / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use; D059408:Pain Management / Q000379:methods; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013280:Stomatitis / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014182:Transplantation, Autologous
chemical_list: D019653:Myeloablative Agonists; D009294:Narcotics; D008558:Melphalan
keywords: Oral cryotherapy; melphalan; multiple myeloma; oral mucositis; stem cell transplant