Multivariate Analysis of Factors Influencing Stomatitis in Allogeneic Hematopoietic Stem Cell Transplantation.

Purpose: Stomatitis in allogenic hematopoietic stem cell transplant (HSCT) recipients sometimes causes serious complications. Stomatitis causes disturbances in oral functioning thus diminishing quality of life (QOL) in transplant patients; these include such simple tasks such as feeding, swallowing and speaking. However, given this serious complication, little information is available regarding the prophylactic effect of oral intervention in hematopoietic stem cell transplantation (HSCT).

Methods: We retrospectively analyzed the incidence and severity of stomatitis after allogeneic HSCT with or without oral intervention among 96 consecutive patients in our hospital between January 1988 and March 2006. Inclusion criteria were

1. conditioning regarding both conventional (CST) and reduced-intensity regimens (RIST),

2. donor source that included both bone marrow and peripheral blood omitting cord blood,

3. HLA disparity eligible to one or two locus mismatched related or unrelated donor.

We used a combination following two strategies; one is cryotherapy which has applied since 2003, and another is oral health care which has been used since 2004. The incidence and severity of stomatitis was evaluated during the start of chemotherapy until day 100 after transplantation. Stomatitis was evaluated according to NCI CTCAE v3.0. ‘Cryotherapy’ is defined as the use of cold to treat an injury. Generally, an ice tip is used to make the mucosa cold. ‘Oral health care’ is defined as a prevention or treatment, including that administered by oneself, encompassing any of the immunologic, sensory, neuromuscular and structural functions of the mouth and craniofacial complex.

Results: The mean age was 42.7 years. Among 96 patients, 41 patients were treated by CST and 55 by RIST. The incidence of stomatitis was 30.9% (17/55) in RIST, which was significantly lower than the 90.2% (37/41) in CST (P < 0.001). Among these 96 patients, severe stomatitis (grade 3 to 4) was observed in 19 (46.3%) CST cases and in 6 (10.9%) RIST cases (P<0.001). The occurrence of stomatitis apparently decreased after oral health care was started. The incidence of overall grade was from 71.1% to 25.6%, and severe grade was from39.6% to 9.3%, at one year. Multiple logistic analysis revealed that both the conditioning regimen as well as the oral health care were independent risk factors for the incidence of stomatitis.

Conclusion: We concluded that although cryotherapy could not prevent oral stomatitis in patients who had undergone CST or RIST, the oral health care improved tissue damage due to an overall upgrade in oral hygiene during chemotherapy.