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Predictors of Oral Mucositis in Patients Receiving Hematopoietic Cell Transplants for Chronic Myelogenous Leukemia

From the Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center; Interdisciplinary Graduate Program in Nutritional Sciences, Departments of Epidemiology and Oral Medicine, School of Dentistry, University of Washington; Oral Medicine Service, Seattle Cancer Care Alliance, Seattle, WA

Address reprint requests to Cornelia Ulrich, PhD, Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, PO Box 19024, M4-B402, Seattle, WA 98109-1024; e-mail: nulrich{at}fhcrc.org

PURPOSE: Oral mucositis is a nearly universal and often severe complication following hematopoietic cell transplantation (HCT). The objective of this study was to evaluate factors predicting oral mucositis severity among 133 patients undergoing allogeneic HCT for chronic myelogenous leukemia.

PATIENTS AND METHODS: All patients were transplanted between 1992 and 1999, were 18 years of age, received either cyclophosphamide/total-body irradiation (TBI) or busulfan/cyclophosphamide conditioning regimens, and received four doses of methotrexate for graft-versus-host disease prophylaxis post-transplant. Oral mucositis was measured by a trained examiner every 2 to 3 days using the Oral Mucositis Index (OMI). Multiple linear regression analysis was used to identify predictors of mean OMI during days 6 to 12, 1 to 18, and the maximum OMI score between days 1 to 18.

RESULTS: TBI containing conditioning regimens, body mass index 25, and methylenetetrahydrofolate reductase 677 TT genotype were found to be predictive of higher mean OMI scores (P < .05). Pretransplant multivitamin supplement use was associated with lower mean OMI scores compared to those who did not use supplements. Smoking status, race, pretransplant treatment with interferon-alfa or hydroxyurea, and patient/donor ABO compatibility were not associated with mean OMI scores.

CONCLUSION: Patients who are scheduled to receive conditioning regimens containing TBI, have a pretransplant body mass index 25, or carry the methylenetetrahydrofolate reductase 677 TT genotype should be considered at greater risk of developing oral mucositis following HCT. Future studies should investigate whether multivitamin supplementation before HCT could reduce mucositis severity.

Supported by National Cancer Institute training grants T32 CA80416 and R25 CA94880 (K.R.).

An abstract based on this research was presented at the American Association for Cancer Research Annual Meeting, Washington, DC, July 11-14, 2003.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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