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CD34+ selection and the severity of oropharyngeal mucositis in total body irradiation-based allogeneic stem cell transplantation.

AbstractOBJECTIVE:
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.
AuthorsAnkit 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
JournalSupportive 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
PMID26190358 (Publication Type: Journal Article, Research Support, N.I.H., Intramural)
Chemical References
  • Antigens, CD34
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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