Glutamine Mouthwash for Preventing Methotrexate-Induced Mucositis in Children with Acute Lymphoblastic Leukemia: A Randomized Cross-Over Trial.

IF 1.7 4区医学 Q2 PEDIATRICS

Indian pediatrics Pub Date : 2025-04-08 DOI:10.1007/s13312-025-00042-4

S Siva Sankaran, Pooja Dewan, Rajeev Kumar Malhotra, Deepika Harit, Bineeta Kashyap, Mukesh Yadav, Mandeep Singh Khalsa

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引用次数: 0

Abstract

Objective: To assess the efficacy of glutamine mouthwash versus standard oral hygiene protocol (SOHP) in reducing the overall incidence, duration and severity of oral mucositis in children with acute lymphoblastic leukemia (ALL) receiving High Dose Methotrexate (HDMTX).

Methods: In this cross-over trial, children with ALL due to receive four courses of HDMTX (2 g/m²/dose) (on days 8, 22, 36, and 50 of consolidation) were randomized to receive two consecutive courses of HDMTX with glutamine mouthwash plus SOHP, followed by two HDMTX courses with SOHP only; or vice-versa. Glutamine suspension was administered twice daily by swish and swallow technique, starting one day before the course of HDMTX and continued upto 7 days or till mucositis persisted. SOHP comprised supervised brushing, chlorhexidine mouthwash, and clotrimazole mouth-paint. Severity of mucositis was graded using WHO grading and pain was assessed by Wong-Baker FACES Pain Rating Scale.

Results: Sixty four courses of HDMTX were analyzed. The overall incidence of mucositis in the glutamine group was comparable to the SOHP group (71.8% vs 81.2%; P = 0.08). The glutamine group had a significantly lesser incidence of severe mucositis [3.1% vs 44%; RR (95% CI) 0.07 (0.01, 0.35); P < 0.001], shorter overall duration of mucositis [2 (0, 3) days vs 5 (3, 5) days, P < 0.001] and lower median (IQR) pain scores [4.5 (0, 6) Vs 8 (5.25, 8), P < 0.001].

Conclusion: Glutamine mouthwash is effective in reducing the incidence of severe mucositis and overall duration of mucositis and associated pain in children receiving HDMTX.

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谷氨酰胺漱口水预防急性淋巴细胞白血病儿童甲氨蝶呤诱导的粘膜炎：一项随机交叉试验。

目的：评价谷氨酰胺漱口水与标准口腔卫生方案（SOHP）在降低接受高剂量甲氨蝶呤（HDMTX）治疗的急性淋巴细胞白血病（ALL）患儿口腔黏膜炎的总体发生率、持续时间和严重程度方面的疗效。方法：在这项交叉试验中，由于接受4个疗程的HDMTX （2g /m2/剂量）（在巩固期的第8、22、36和50天）而患有ALL的儿童随机接受两个连续疗程的HDMTX联合谷氨酰胺漱口水加SOHP，随后两个疗程的HDMTX只加SOHP；反之亦然。谷氨酰胺混悬液每日2次，在HDMTX疗程前1天开始，持续至7天或直到粘膜炎持续。SOHP包括监督刷牙，氯己定漱口水和克霉唑口腔涂料。黏膜炎的严重程度采用WHO分级，疼痛采用Wong-Baker FACES疼痛评定量表进行评定。结果：对64个疗程的HDMTX进行分析。谷氨酰胺组粘膜炎的总发病率与SOHP组相当(71.8% vs 81.2%；p = 0.08)。谷氨酰胺组严重粘膜炎的发生率显著降低[3.1% vs 44%；Rr (95% ci) 0.07 (0.01, 0.35)；结论：谷氨酰胺漱口水可有效降低接受HDMTX治疗的儿童严重黏膜炎的发生率、黏膜炎的总持续时间及相关疼痛。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Indian pediatrics 医学-小儿科

CiteScore

3.30

自引率

8.70%

发文量

344

审稿时长

3-8 weeks

期刊介绍： The general objective of Indian Pediatrics is "To promote the science and practice of Pediatrics." An important guiding principle has been the simultaneous need to inform, educate and entertain the target audience. The specific key objectives are: -To publish original, relevant, well researched peer reviewed articles on issues related to child health. -To provide continuing education to support informed clinical decisions and research. -To foster responsible and balanced debate on controversial issues that affect child health, including non-clinical areas such as medical education, ethics, law, environment and economics. -To achieve the highest level of ethical medical journalism and to produce a publication that is timely, credible and enjoyable to read.