Effect Of Amifostine For The Prevention Of Oral Mucositis In Allogeneic Hematopoietic Stem Cell Transplantation

Background and Objectives:Hematopoietic stem cell transplantation is one of the main treatment of hematologic malignancies.Oral mucositis is a common complication in hematopoietic stem cell transplantation after conditioning.In particular, it is more significant in allogeneic stem cell transplantation oral mucositis. The major clinical manifestations of oral mucositis are pain, oral mucosal erythema, ulcer, necrosis and pseudomembrane. It can affect eating, lead to a serious decline in quality of life, or even delay further treatment, or more likely to be the portal that bacteria, fungi, viruses and other infectious invasion during the period of neutropenia after chemotherapy, then leading to serious systemic infection, or septicemia, cause death in patients. Therefore, reduce the incidence of oral mucositis, severity, shorten the course of the disease, not only can reduce the pain of patients, but also to reduce the incidence of complications related to. Amifostine is a broad-spectrum selective cytoprotective agent; it protects a variety of normal tissue damage from chemotherapy, owns fewer side effects, and does not affect the chemotherapy drugs on tumor cell-killing effect. Amifostine reduces mucosal damage after high-dose melphalan conditioning and autologous peripheral blood progenitor cell transplantation for patients with multiple myeloma. The incidence of oral mucositis is higher in allogeneic hematopoietic stem cell transplantation. In view of this, this study aims to explore the effect of amifostine for the prevention of oral mucositis caused by allogeneic hematopoietic stem cell transplantation.Subjects and methods:Select 20 patients who are going to complete allogeneic hematopoietic stem cell transplantation received amifostine before conditioning during January 2008 to November 2010 as experimental group,20 patients who are going to complete allogeneic hematopoietic stem cell transplantation but not received amifostine during January 2008 to November 2010 as control group. The specific information of the two groups are discripted as follows:of the experimental group, there are 13 males, 7 females, the median age is 22.5 (range 14-46 years old), including 5 patients with ALL,9 with AML,6 with CML; of the control group, there are 13 males,7 females, the median age is 23.5(range 15-45 years old), including 9 patients with ALL,7 with AML,4 with CML. Compare the sex, age and diagnose characteristics of the two groups, the P values are greater than 0.05. Amifostine 500mg had been intravenously given to the 20 patients of experimental group 30 minutes before chemotherapy. The persistence time was 15 minutes, while nothing had been given to the 20 patients of control group. Since the conditioning starts, observe and record oral mucositis in location, size, extent, pain and diet daily, until the ulcer healed. Observe the status of oral mucosa According to World Health Organization grading system, as follows: grade 0-indicated absence of mucositis; gradeⅠ-presence of a painless ulcer, erythema or mild sensitivity; gradeⅡ-presence of painful erythema or ulcers that do not interfere with the patient's ability to take food; gradeⅢ-confluent ulceration that interfere with the patient's ability to take solid food; and gradeⅣ-severe symptoms requiring enteral or parenteral support. Results:The incidence of oral mucositis of experimental group was 55%, control group 90%(P=0.031), the incidence of severe oral mucositis of experimental group was 10%, the incidence of severe oral mucositis of control group was 50%(P=0.014). The average duration of oral mucositis of experimental group was 13.18 days, control group 17.16 days (P=0.006).Conclusion:The effect of amifostine to prevent oral mucositis in allogeneic hematopoietic stem cell transplantation is obvious. It can significantly reduce the incidence of oral mucositis and the severity in allogeneic hematopoietic stem cell transplantation and shorten the duration of oral mucositis.