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

• Published in: Supportive care in cancer Vol. 27; no. 3; pp. 839 - 848
• Main Authors: Eduardo, Fernanda P., Bezinelli, Leticia Mello, Gobbi, Marcella, Rosin, Flavia C. P., Carvalho, Danielle L. C., Ferreira, Mariana Henriques, da Silva, Cinthya Correa, Hamerschlak, Nelson, Corrêa, Luciana
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2019; Springer; Springer Nature B.V
• Subjects: Antineoplastic agents; Busulfan; Cancer treatment; Chemotherapy; Diarrhea; Erythema; Esophagus; Gastrointestinal system; Graft versus host disease; Health aspects; Hematology; Hematopoietic stem cell transplantation; Infections; Medical records; Medicine; Medicine & Public Health; Mortality; Mucositis; Narcotics; Nursing; Nursing Research; Nutrition; Oncology; Opioids; Original Article; Pain Medicine; Patients; Rehabilitation Medicine; Risk factors; Stem cell transplantation; Toothbrushing; Toxicity; Gastrointestinal mucositis; Hematopoietic cell transplantation; Oral mucositis; Busulfan
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-018-4362-3

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 ≥ 5 days (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.