La mucite post-allogreffe de cellules souches hématopoïétiques : facteurs de risque, conséquences cliniques et prévention

Aim

Oral mucositis is a very common complication of allograft. However, preventive treatments are still limited. The objective of this study is to identify risk factors for onset of oral mucositis in patients undergoing allogeneic hematopoietic stem cells transplantation (HSCT), to measure clinical consequences and to study their evolution according to type of prevention.

Patients and methods

All patients undergoing HSCT in hematology unit of CHU Besançon between January 2009 and August 2010 were included, and received according to their choice, either the standard protocol: solution of sodium bicarbonate 1.4% associated with chlorhexidine-chlorobutanol (Eludril^®) (n = 49), or the experimental treatment by the ionic solution, Caphosol^® (n = 42).

Results

The overall incidence of severe mucositis and mucositis is respectively 69% and 36%. In multivariate analysis, a myeloablative conditioning (OR = 11.1) and prevention of GVHD (graft-versus-host disease) including methotrexate (OR = 7.5) appear such as the two significant mucositis risk factors. The presence of mucositis resulting in a significant increase in the incidence of febrile aplasia (P = 0.008) and the use of opioid analgesics and parenteral nutrition (P < 10⁻³). The risk of acute gastrointestinal GVHD is also increased in severe mucositis (P = 0.01). The duration of post-transplant hospitalization is not changed. The type of prevention does not influence the incidence of mucositis (P = 0.11).

Conclusion

The consequences of mucositis are significant and the risk factors identified. The interest of the ionic solution Caphosol^® seems limited, the incidence of mucositis is not decreased by this prevention.