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Post-Transplant Events

Cryotherapy in the prevention of oral mucositis in patients receiving low-dose methotrexate following myeloablative allogeneic stem cell transplantation: a prospective randomized study of the Gruppo Italiano Trapianto di Midollo Osseo nurses group

Bone Marrow Transplantation volume 39, pages 347–352 (2007)Cite this article

Abstract

Severe oral mucositis is a major cause of morbidity following allogeneic hematopoietic stem cell transplantation (AHSCT). Cryotherapy, that is, the application of ice chips on the mucosa of the oral cavity during the administration of antineoplastic agents, may reduce the incidence and severity of chemotherapy-related oral mucositis. In this multicenter randomized study, we addressed whether cryotherapy during MTX administration is effective in the prevention of severe oral mucositis in patients undergoing myeloablative AHSCT. One hundred and thirty patients undergoing myeloablative AHSCT and MTX-containing GVHD prophylaxis were enrolled and randomized to receive or not receive cryotherapy during MTX administration. The incidence of severe (grade 3–4) oral mucositis, the primary end point of the study, was comparable in patients receiving or not cryotherapy. Moreover, no difference was observed in the incidence of oral mucositis grade 2–4 and the duration of oral mucositis grade 3–4 or 2–4, or in the kinetics of mucositis over time. In univariate and multivariate analysis, severe oral mucositis correlated with TBI in the conditioning regimen and lack of folinic acid rescue following MTX administration. Thus, cryotherapy during MTX administration does not reduce severe oral mucositis in patients undergoing myeloablative allogeneic HSCT. Future studies will assess cryotherapy before allogeneic HSCT.

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Acknowledgements

We thank the Italian HSCT Nurses Group (GITMO) for sponsoring the study. We also thank the staff of the HSCT unit at the Institute of Hematology and Medical Oncology Seragnoli, who cared for the patients: Marta Stanzani, Maria Benedetta Giannini, Maddalena Giovannini, Vanessa Sabbi, Emanuela Innocenti, Caterina Guarnaccio, Lucia Bertei, Serena Orlandi, Daniele Bortolotti and Francesco Talarico.

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Authors and Affiliations

  1. Department of Hematology and Medical Oncology ‘Seragnoli’, University of Bologna, Bologna, Italy

    E Gori, M Arpinati, F Bonifazi, F Alberani, V Sabbi, G Bandini, A De Vivo & M Baccarani

  2. Department of Hematology, HSCT Unit, Hospital ‘Careggi’, University of Florence, Florence, Italy

    A Errico & A Bosi

  3. Department of Hematology, Institute of Internal Medicine, Hospital ‘Gemelli’, Catholic University of Rome, Rome, Italy

    A Mega

  4. Department of Hematology, Hospital ‘Centro-Sud’, Bolzano, Italy

    G Costazza

  5. Department of Hematology, Hospital S.G. Battista, University of Torino, Torino, Italy

    S Leanza

  6. Department of Hematology, University Hospital of Siena, Siena, Italy

    C Borrelli & M Berni

  7. Department of Hematology, Hospital ‘Regina Margherita’, University of Torino, Torino, Italy

    C Feraut

  8. Department of Hematology, Hospital S.Bortolo, Vicenza, Italy

    E Polato

  9. Department of Hematology, Hospital ‘S.Gerardo dei Tintori’, Monza, Italy

    M C Altieri & E Pirola

  10. Department of Hematology, Hospital ‘R. Binaghi’, University of Cagliari, Cagliari, Italy

    M C Loddo

  11. Department of Hematology, Hospital Maggiore IRCCS, University of Milano, Milano, Italy

    M Banfi

  12. Department of Hematology, Hospital ‘Umberto I’, University of Ancona, Ancona, Italy

    L Barzetti

  13. Department of Hematology, Hospital ‘Gaslini’, University of Genova, Genova, Italy

    S Calza

  14. Department of Hematology, Hospital of Bergamo, Bergamo, Italy

    C Brignoli

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  1. E Gori
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  2. M Arpinati
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  3. F Bonifazi
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  4. A Errico
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  5. A Mega
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  6. F Alberani
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  7. V Sabbi
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  8. G Costazza
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  9. S Leanza
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  10. C Borrelli
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  11. M Berni
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  12. C Feraut
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  13. E Polato
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  14. M C Altieri
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  15. E Pirola
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  16. M C Loddo
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  17. M Banfi
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  18. L Barzetti
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  19. S Calza
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  20. C Brignoli
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  21. G Bandini
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  22. A De Vivo
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  23. A Bosi
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  24. M Baccarani
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Corresponding author

Correspondence to M Arpinati.

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Gori, E., Arpinati, M., Bonifazi, F. et al. Cryotherapy in the prevention of oral mucositis in patients receiving low-dose methotrexate following myeloablative allogeneic stem cell transplantation: a prospective randomized study of the Gruppo Italiano Trapianto di Midollo Osseo nurses group. Bone Marrow Transplant 39, 347–352 (2007). https://doi.org/10.1038/sj.bmt.1705590

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