Abstract | OBJECTIVE: The purpose of the present study was to evaluate the impact of ex vivo T cell depleted (TCD) by CD34+ selection on the incidence and severity of oropharyngeal mucositis (OM) after myeloablative allogeneic stem cell transplant (allo-SCT) with total body irradiation (TBI) conditioning. This approach has the advantage of avoiding methotrexate for graft versus host disease (GVHD) prophylaxis. PATIENTS AND METHODS: We analyzed the incidence and severity of OM in a cohort of 105 consecutive patients who underwent CD34+ selected (peripheral blood stem cells (PBSCs) from human leukocyte antigen (HLA)-identical siblings) allo-SCT with total body irradiation (TBI) conditioning. OM was graded by the World Health organization (WHO) and the Bearman regimen-related toxicity (RRT) scales. RESULTS: The incidence of WHO grade 3-4 OM was 34.3 %. There were no cases of grade 3-4 OM by the RRT scale. Significant correlation was found between the severity of OM and the use of intravenous (IV) narcotic medications (r (2) = 0.15, p = 0.004), total parenteral nutrition (TPN; r (2) = 0.68, p < 0.001), and hospital length of stay (LOS) (r (2) = 0.12, p = 0.01). DISCUSSION: TBI-induced OM can inflict significant morbidity in the early transplant period, and the incidence of WHO grade 3-4 OM can exceed 50 % when methotrexate is used for GVHD prophylaxis. In the CD34+ selected setting, methotrexate is avoided and the incidence of WHO grade 3-4 OM, use of TPN, and need for narcotic analgesia appear to be lower than historic evidence from standard T-replete allogeneic transplantation. CONCLUSION: We conclude that toxicity from OM is tolerable in CD34+ selected allo-SCT and should be prospectively measured in randomized trials comparing CD34+ selection versus T-replete transplantation.
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Authors | Ankit Anand, Prathima Anandi, Natasha A Jain, Kit Lu, Neil Dunavin, Christopher S Hourigan, Robert Q Le, Puja D Chokshi, Sawa Ito, David F Stroncek, Marianna Sabatino, A John Barrett, Minoo Battiwalla |
Journal | Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
(Support Care Cancer)
Vol. 24
Issue 2
Pg. 815-822
(Feb 2016)
ISSN: 1433-7339 [Electronic] Germany |
PMID | 26190358
(Publication Type: Journal Article, Research Support, N.I.H., Intramural)
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Chemical References |
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Topics |
- Adult
- Antigens, CD34
(blood)
- Female
- Graft vs Host Disease
(drug therapy)
- Hematopoietic Stem Cell Transplantation
(adverse effects)
- Humans
- Male
- Middle Aged
- Mouth Diseases
(etiology)
- Mucositis
(etiology)
- Pharyngeal Diseases
(etiology)
- Severity of Illness Index
- T-Lymphocytes
(immunology)
- Transplantation Conditioning
(adverse effects)
- Transplantation, Homologous
- Whole-Body Irradiation
(methods)
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