A prospective, double-blind phase II study evaluating the safety and efficacy of a topical histamine gel for the prophylaxis of oral mucositis in patients post hematopoietic stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 37; no. 8; pp. 757 - 762
• Main Authors: ELAD, S, ACKERSTEIN, A, OR, R, BITAN, M, SHAPIRA, M. Y, RESNICK, I, GESUNDHEIT, B, COHEN, Y, DISS, O, BARAK, D, DRAY, L
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.04.2006
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-inflammatory agents; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Complications and side effects; Dosage and administration; Double-Blind Method; Double-blind studies; Evaluation; Facial bones, jaws, teeth, parodontium: diseases, semeiology; Female; Flow velocity; Gels (Pharmacy); Gels - therapeutic use; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Histamine; Histamine - therapeutic use; Humans; Inflammation; Male; Medical sciences; Middle Aged; Mucositis; Non tumoral diseases; Otorhinolaryngology. Stomatology; Pain; Placebos; Prevention; Prophylaxis; Prospective Studies; Random Allocation; Reproducibility of Results; Safety; Safety and security measures; Stem cell transplantation; Stem cells; Stomatitis; Stomatitis - etiology; Stomatitis - prevention & control; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Treatment Outcome; Human; Mucositis; Hematology; Stomatology; Stem cell; Hematopoietic cell; Prospective; Prevention; Histamine; Local administration; Stomatitis; Treatment; Phase II trial; Double blind study; Graft; Oral cavity disease; oral; Mucosa disease; HSCT; histamine dihydrochloride
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705331

The aim of this study was to evaluate the safety, tolerability and efficacy of a topical gel containing histamine dihydrochloride (HDC) versus a placebo gel in preventing oral mucositis in hematopoietic stem cell transplantation (HSCT) patients. A total of 45 patients post-HSCT were enrolled in a prospective longitudinal, placebo-controlled, double-blind study. Patients were evaluated twice weekly for oral mucositis (OMAS, NCI score), oral pain (VAS), oral function and salivary flow rate. Compliance was assessed using a patient diary. Oral mucositis developed in 85% of the HDC group and 63% of the placebo group. The mean maximal intensity for NCI score was 1.45+/-1 in the HDC group and 1.21+/-1.27 in the placebo group (P=0.37). The mean duration of oral mucositis was 4.7+/-3.6 and 2.33+/-2.23 days in the HDC and placebo groups, respectively (P=0.06). The same trends were measured with OMAS. Visual analogue scale for oral pain and oral function was not significantly different between the two groups. Histamine dihydrochloride was found to be safe. In the search for topical agents for the prevention of mucositis, we found that HDC neither improves nor worsens oral mucositis in HSCT patients. The balance between the pro- and anti-inflammatory effects of HDC should be investigated further in order to acquire a clinically effective topical medication based on its anti-inflammatory properties.