Originally published as JCO Early Release 10.1200/JCO.2007.13.6028 on February 11 2008

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Prospective Oral Mucositis Audit: Oral Mucositis in Patients Receiving High-Dose Melphalan or BEAM Conditioning Chemotherapy—European Blood and Marrow Transplantation Mucositis Advisory Group

Nicole Blijlevens, Matthias Schwenkglenks, Pamela Bacon, Alessandra D'Addio, Hermann Einsele, Johan Maertens, Dietger Niederwieser, Werner Rabitsch, Ann Roosaar, Tapani Ruutu, Harry Schouten, Rebecca Stone, Samuel Vokurka, Barry Quinn, Shaun McCann

From the Department of Hematology, University Medical Centre St Radboud, Nijmegen; University Hospital Maastricht, Maastricht, the Netherlands; European Center of Pharmaceutical Medicine, University of Basel, Basel; Amgen (Europe) GmbH, Zug, Switzerland; Institute of Hematology and Medical Oncology "L. and A. Seragnoli", Bologna, Italy; Department of Internal Medicine II, University Medical Center Würzburg; Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany; Department of Hematology, Universitaire Ziekenhuizen Leuven, Catholic University, Leuven, Belgium; Bone Marrow Transplantation Unit, Medical University of Vienna, Austria; Karolinska Institute, Inst of Odontology, Huddinge, Huddinge, Sweden; Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Nottingham City Hospital National Health Service Trust, Nottingham; Royal Marsden School of Cancer Nursing and Rehabilitation, London, United Kingdom; University Hospital Alej Svobody 80, Plzen, Czech Republic; and St James Hospital, Trinity College, Dublin, Ireland

Corresponding author: Nicole Blijlevens, MD, Department of Hematology, University Medical Center St Radboud, PO Box 9101 6500 HB Nijmegen, the Netherlands; e-mail: n.blijlevens{at}hemat.umcn.nl

Purpose: The Prospective Oral Mucositis Audit assessed the incidence, duration, and determinants of severe oral mucositis (OM; WHO oral toxicity scale grades 3 to 4) in patients with multiple myeloma (MM) or non-Hodgkin's lymphoma (NHL) receiving high-dose conditioning chemotherapy before autologous stem-cell transplantation.

Patients and Methods: Patients with MM (n = 109; mean age, 57 ± 8 years) or NHL (n = 88; mean age, 50 ± 13 years) were treated with high-dose melphalan (200 mg/m²) or carmustine 300 mg/m², etoposide 800 mg/m², cytarabine 800 to 1,600 mg/m², and melphalan 140 mg/m² chemotherapy, respectively, in 25 European centers. OM assessments were made daily until 30 days after transplantation or hospital discharge. High quality of OM assessment was ensured by an intensive training program.

Results: Severe OM occurred in 46% (95% CI, 36% to 56%) of patients with MM and 42% (95% CI, 32% to 53%) of patients with NHL, with a mean duration of 5.3 days (95% CI, 4.4 to 6.1 days) and 5.5 days (95% CI, 4.5 to 6.7 days), respectively. Time from start of conditioning to peak OM score was 12.1 ± 2.6 and 14.6 ± 2.4 days. Severe OM risk and/or duration was significantly associated with higher chemotherapy dose per kilogram of body weight and poor performance status, but in contrast with some previous reports, this was not related to age.

Conclusion: Severe OM is more common in the transplantation setting than previously reported, justifying effective preventative and therapeutic measures.

published online ahead of print at www.jco.org on February 11, 2008.

Supported by Amgen (Europe) GmbH, Zug, Switzerland.

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