Retrospective study of the digestive tract mucositis derived from myeloablative and non-myeloablative/reduced-intensity conditionings with busulfan in hematopoietic cell transplantation patient

Author(s)

Eduardo, Fernanda P. ^[1] ; Bezinelli, Leticia Mello ^[1] ; Gobbi, Marcella ^[1] ; Rosin, Flavia C. P. ^[1] ; Carvalho, Danielle L. C. ^{[1, 2]} ; Ferreira, Mariana Henriques ^{[1, 2]} ; da Silva, Cinthya Correa ^[1] ; Hamerschlak, Nelson ^[1] ; Correa, Luciana ^[2]

Affiliation

^[1] HIAE, Hematol Oncol, Ave Albert Einstein 627-701, BR-05652900 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Dent, Gen Pathol Dept, Ave Prof Lineu Prestes 2227, BR-05508000 Sao Paulo - Brazil

• Document type: Journal article
• Source: SUPPORTIVE CARE IN CANCER; v. 27, n. 3, p. 839-848, MAR 2019.
• Web of Science Citations: 0

Abstract

Busulfan is a major component of chemotherapy conditioning in hematopoietic cell transplantation (HCT). This alkylating agent is highly toxic at myeloablative doses, exposing HCT patients to risks of mortality. Non-myeloablative (NMA) and reduced-intensity conditioning (RIC) using busulfan have shown impaired toxicity. However, the toxicity of NMA/RIC in the digestive tract is poorly described. This study aimed to characterize the mucositis in the oral cavity (OM), oropharynx/esophagus, and gastrointestinal tract derived from conditionings with myeloablative and non-myeloablative doses of busulfan. We retrospectively retrieved clinical data of HCT patients (n=100) who underwent myeloablative conditioning (MAC) or NMA/RIC with busulfan. Frequency and time duration of mucositis in the oral cavity and oropharynx/esophagus, diarrhea, and prescription of total parenteral nutrition (TPN) and opioids were also collected. OM severity (p=0.009) and time duration of mucositis in oropharynx/esophagus (p=0.022) were frequently higher in MAC than NMA/RIC. A myeloablative dose of busulfan was a risk factor for OM grade 2 (OR=4.8, p=0.002) and for mucositis in oropharynx/esophagus 5days (OR=2.64, p=0.035). A longer duration of mucositis in the oropharynx/esophagus was also associated with an increase in the prescription of opioids (OR=7.10, p<0.001).Overall survival (OS) in MAC was significantly higher than that in NMA/RIC (p=0.017). No variables related to mucositis interfere significantly in OS. In conclusion, myelosuppression in busulfan-based regimens are predisposed to a high risk for severe OM and to prolonged mucositis in the oropharynx/esophagus. (AU)

• FAPESP's process: 16/03650-4 - Salivary and serum concentrations of busulfan and their association with salivary alterations and mucositis in patients undergoing hematopoietic stem cell transplantation.
• Grantee: Fernanda de Paula Eduardo Simões
• Support Opportunities: Regular Research Grants