Oral mucositis in myeloma patients undergoing melphalan-based autologous stem cell transplantation: Incidence, risk factors and a severity predictive model

M. L. Grazziutti, L. Dong, M. H. Miceli, S. G. Krishna, E. Kiwan, N. Syed, A. Fassas, F. van Rhee, H. Klaus, B. Barlogie, E. J. Anaissie

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70 Scopus citations

Abstract

Melphalan-based autologous stem cell transplant (Mel-ASCT) is a standard therapy for multiple myeloma, but is associated with severe oral mucositis (OM). To identify predictors for severe OM, we studied 381 consecutive newly diagnosed myeloma patients who received Mel-ASCT. Melphalan was given at 200 mg/m2 body surface area (BSA), reduced to 140 mg/m2 for serum creatinine > 3 mg/dl. Potential covariates included demographics, pre-transplant serum albumin and renal and liver function tests, and mg/kg melphalan dose received. The BSA dosing resulted in a wide range of melphalan doses given (2.4-6.2 mg/kg). OM developed in 75% of patients and was severe in 21%. Predictors of severe OM in multiple logistic regression analyses were high serum creatinine (odds ratio (OR = 1.581; 95% confidence interval (CI): 1.080-2.313; P = 0.018) and high mg/kg melphalan (OR = 1.595; 95% CI: 1.065-2.389; P = 0.023). An OM prediction model was developed based on these variables. We concluded that BSA dosing of melphalan results in wide variations in the mg/kg dose, and that patients with renal dysfunction who are scheduled to receive a high mg/kg melphalan dose have the greatest risk for severe OM following Mel-ASCT. Pharmacogenomic and pharmacokinetic studies are needed to better understand interpatient variability of melphalan exposure and toxicity.

Original languageEnglish (US)
Pages (from-to)501-506
Number of pages6
JournalBone Marrow Transplantation
Volume38
Issue number7
DOIs
StatePublished - Oct 1 2006

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ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Grazziutti, M. L., Dong, L., Miceli, M. H., Krishna, S. G., Kiwan, E., Syed, N., Fassas, A., van Rhee, F., Klaus, H., Barlogie, B., & Anaissie, E. J. (2006). Oral mucositis in myeloma patients undergoing melphalan-based autologous stem cell transplantation: Incidence, risk factors and a severity predictive model. Bone Marrow Transplantation, 38(7), 501-506. https://doi.org/10.1038/sj.bmt.1705471