Dilek BAYKAL, Dilek YILDIRIM, GÜLBEYAZ CAN

Kök Hücre Transplantasyonu Uygulanan Hastalarda Oral Mukozite Yönelik Çalısmaların Gözden Geçirilmesi

Kök hücre transplantasyonu yapılan hastaların büyük kısmında oralmukozit, hastaların yasam kalitesini olumsuz yönde etkileyen önemlisorunlardan biridir. Hastanın beslenmesini olumsuz etkileyerek, parenteralbeslenmenin ve agrıya neden olarak opioid tedavilerin baslanmasınaneden olur. Hastanın hastanede kalıs süresinin uzamasınaneden olarak, hastane maliyetlerinin artmasına yol açmaktadır. Bazıhastalarda uzun süreli tedavi sonuçlarını da olumsuz etkileyebilmektedir.Yönetiminde, nakil öncesi hastanın dis hekimligine yönlendirilerekdis bakımının yapılması, düsük doz lazer tedavi (DDLT) uygulanması,nakil sırasında temel agız bakımının sürdürülmesi ve kriyoterapininuygulanması etkinligi gösterilmis non-farmakolojik yaklasımlardır.Farklı çalısmalarda, kapsamlı agız bakımının düzenli yapılması, varolan oral mukozitlerin siddetini ve süresini azalttıgı, DDLT siddetli oralmukozitin gelisimini engelledigi ve olusan mukozitin iyilesme sürecinihızlandırdıgı, tek basına DDLT uygulanması ile kıyaslandıgında DDLTile birlikte kriyoterapinin uygulanmasının oral mukozitlerin iyilestirilmesindedaha yararlı oldugu saptanmıstır.Bu derleme kök hücre transplantasyonu tedavisi uygulanan hastalardaoral mukozite yönelik çalısmaların gözden geçirilmesi amacıyla yazılmıstır.

A Review of Oral Mucositis Studies in Post Stem Cell Transplant Patients

Oral mucositis is one of the most important issues affecting the quality of life in the majority of patients undergoing stem cell transplantation. It negatively affects the nutrition of the patient and leads to the administration of parenteral nutrition as well as opioid therapies due to the onset of pain, a prolonged hospital stay, and an increase in hospital costs. It may also adversely affect long-term treatment results in some patients. Non-pharmacological approaches such as administering low-dose laser treatment (LDLT), maintaining basic oral care during transfer, and administering cryotherapy have been shown to be effective in oral care management. In different studies, it was found that regular oral care decreases the severity and duration of existing oral mucositis, LDLT prevents the development of severe oral mucositis and accelerates the mucositis recovery process, and cryotherapy with LDLT is more effective in the treatment of oral mucositis compared to LDLT alone. This review has been written to overview oral mucositis studies in post stem cell transplant patients.

PDF

___

1 . Elad S, Raber-Durlacher JE, Brennan MT, et al. Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: A position paper from the joint task force of the multinational association of supportive care in cancer/ınternational society of oral oncology (MASCC/ISOO) and the european society for blood and marrow transplantation (EBMT). Support Care Cancer. 2015;23(1):223-36. doi: 10.1007/s00520-014-2378-x.
2 . Rubenstein EB, Peterson DE, Schubert M, et al. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer. 2004;100:2026-46. doi:10.1002/cncr.20163.
3 . Wohlschlaeger A. Prevention and treatment of mucositis: A guide for nurses. J Pediatr Oncol Nurs. 2004;21:281-87. doi: 10.1177/1043454204265840.
4 . Can G. Onkoloji Hemsireleri Dernegi Uygulama Rehberleri Komisyonu Mukozit Cep Rehberi. 1. Baskı. Istanbul: Onkoloji Hemsireligi Dernegi Yayını; 2009.
5 . Yılmaz MÇ. Mukozit yönetiminde kanıta dayalı uygulamalar. International Journal of Hematology and Oncology. 2007;4:241-6. Available from: http://uhod.org/pdf/PDF_303.pdf
6 . Sonis ST, Elting LS, Keefe D, et al. Perspectives on cancer therapyinduced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer. 2004;100:1995-2025. doi: 10.1002/cncr.20162.
7 . Tinoco-Araujo JE, Orti-Raduan ES, Santos D, et al. Oral health-related quality of life before haematopoietic stem cell transplant. Clin Oral Investig. 2015;19(9):2345-9. doi: 10.1007/s00784-015-1464-x.
8 . Patussi C, Sassi LM, Munhoz EC, Zanicotti RT, Schussel JL. Clinical assessment of oral mucositis and candidiasis compare to chemotherapic nadir in transplanted patients. Braz Oral Res. 2014;28(1):1-7. doi:10.1590/1807-3107bor-2014.vol28.0050.
9 . Fall-Dickson JM, Mock V, Berk RA, Grimm PM, Davidson N, Gaston- Johansson F. Stomatitis-related pain in women with breast cancer undergoing autologous hematopoietic stem cell transplant. Cancer Nurs. 2008;31(6):452-61. doi: 10.1097/01.NCC.0000339244.58914.4a.
10 . Barracha RH, Souza MP, Silvaa DP, Lopez PS, Montovani JC. Oral changes in individuals undergoing hematopoietic stem cell transplantation. Braz J Otorhinolaryngol. 2015;81(2):141-7. doi: 10.1016/j.bjorl.2014.04.004.
11 . Raida L, Rusinakova Z, Faber E, et al. Comparison of reduced conditionings combining udarabine with melphalan or 3-day busulfan in patients allografted for myeloid neoplasms. International Journal of Hematology. 2014;100(6):582-91. doi: 10.1007/s12185-014-1684-x.
12 . Blijlevens N, de Château M, Krivan G, et al. In a high-dose melphalan setting, palifermin compared with placebo had no effect on oral mucositis or related patient’s burden. Bone Marrow Transplantation. 2013;48:966-71. doi: 10.1038/bmt.2012.257.
13 . Kefe DM, Schubert MM, Elting LS, et.al. Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer. 2007;109:820-31. doi: 10.1002/cncr.22484.
14 . Lalla RV, Bowen J, Barasch A, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014;120(10):1453-61. doi: 10.1002/cncr.28592.
15 . Santos PS, Coracin FL, Barros JC, Dulley FL, Nunes FD, Magalhães MG. Impact of oral care prior to hsct on the severity and clinical outcomes of oral mucositis. Clin Transplant. 2011;25(2):325-8. doi: 10.1111/j.1399-0012.2010.01283.x.
16 . Bosden Braber J, Potting CM, Bronkhorst EM, Huysmans MC, Blijlevens NM. Oral complaints and dental care of hematopoietic stem cell transplant patients: A qualitative survey of patients and their dentists. Support Care Cancer. 2015;23:13-9. doi: 10.1007/s00520-014-2297-x.
17 . Silva GB, Sacono NT, Othon-Leite AF, et al. Effect of low-level laser therapy on in ammatory mediator release during chemotherapyinduced oral mucositis: A randomized preliminary study. Lasers Med Sci. 2015;30:117-26. doi: 10.1007/s10103-014-1624-2.
18 . De Paula Eduardo F, Bezinelli LM, Da Graça Lopes RM, Nascimento Sobrinho JJ, Hamerschlak N, Correa L. Efficacy of cryotherapy associated with laser therapy for decreasing severity of melphalaninduced oral mucositis during hematological stem-cell transplantation: A prospective clinical study. Hematol Oncol. 2014;5:1-12. doi: 10.1002/hon.2133.
19 . Oberoi S, Zamperlini-Netto G, Beyene J, Treister NS, Sung L. Effect of prophylactic low level laser therapy on oral mucositis: A systematic review and meta-analysis. PLus One. 2014;9(9):1-10. doi: 10.1371/ journal.pone.0107418.
20 . Çıtlak K, Kapucu S. Kemoterapi alan hastalarda görülen oral mukozitin önlemesi ve tedavisinde güncel yaklasımlar: Kanıta dayalı uygulamalar. Hacettepe Üniversitesi Hemsirelik Fakültesi Dergisi. 2015;2(1):70-7. Available from: http://dergipark.ulakbim.gov.tr/hunhemsire/article/ view/5000154797.
21 . Svanberg A, Öhrn K, Birgegard G. Caphosol mouthwash gives no additional protection against oral mucositis compared to cryotherapy alone in stem cell transplantation. A pilot study. European Journal of Oncology Nursing. 2015;19(1):50-3. doi: 10.1016/j.ejon.2014.07.011.
22 . Lu Y, Zhu X, Depei W. Oral cryotherapy for the prevention of mucositis following myeloablative conditioning and hematopoietic stem cell transplantation. Blood. 2013;122(21):5466. doi: 10.1038/sj. bmt.1705590.
23 . Orvain C, Moles-Moreau MP, François S, et al. Miconazole mucoadhesive buccal tablet in high-dose therapy with autologous stem cell transplantation (HDT/ASCT)-induced mucositis. Support Care Cancer. 2015;23:359-64. doi: 10.1007/s00520-014-2365-2.
24 . Carulli G, Rocco M, Panichi A, et al. Treatment of oral mucositis in hematologic patients undergoing autologous or allogeneic transplantation of peripheral blood stem cells: A prospective, randomized study with a mouthwash containing camelia sinensis leaf extract. Hematology Reports. 2013;5(1):21-5. doi: 10.4081/hr.2013. e6.
25 . Vokurka S, Skardova J, Hruskova R, et al. The effect of polyvinylpyrrolidone-sodium hyaluronate gel (Gelclair) on oral microbial colonization and pain control compared with other rinsing solutions in patients with oral mucositis after allogeneic stem cells transplantation. Med Sci Monit. 2011;17(10):572-6. doi: 10.12659/ MSM.881983.
26 . Hodgson BD, Margolis DM, Salzman DE, et al. Amelioration of oral mucositis pain by nasa near-infrared light-emitting diodes in bone marrow transplant patients. Support Care Cancer. 2012;20:1405-15. doi: 10.1007/s00520-011-1223-8.
27 . Elad S, Thierer T. Cost-effective analysis of topical chlorhexidine in hematologic patients at risk for oral mucositis. Clin Oral Invest. 2015;19(8):1843-50. doi: 10.1007/s00784-015-1438-z.
28 . Bourdelin M, Daguindau E, Larosa F, et al. Mucositis after allogeneic stem cell transplantation: risk factors, clinical consequences and prophylaxis. Pathol Biol (Paris). 2015;63(2):106-10. doi: 10.1016/j. patbio.2014.11.001.
29 . Mutters NT, Neubert TR, Nieth R, Mutters R. The role of octenidol, glandomed and chlorhexidine mouthwash in the prevention of mucositis and in the reduction of the oropharyngeal ora: A doubleblind randomized controlled trial. GMS Hyg Infect Control. 2015;10:1- 7. doi: 10.3205/dgkh000248.
30 . Hayashi H, Kobayashi R, Suzuki A, et al. Polaprezinc prevents oral mucositis in patients treated with high-dose chemotherapy followed by hematopoietic stem cell transplantation. Anticancer Research. 2014;34(12):7271-8. Available from: https://pdfs.semanticscholar. org/0a6c/b31f44492eece25f475548c1248295c4a843.pdf
31 . Vadhan-Raj S, Goldberg DJ, Perales MA, Berger DP, Brink MR. Clinical applications of palifermin: amelioration of oral mucositis and other potential ındications. J Cell Mol Med. 2013;17(11):1371-84. doi: 10.1111/jcmm.12169.
32 . Goldberg JD, Zheng J, Castro-Malaspina H, et al. Palifermin is ef cious in recipients of tbı-based but not chemotherapy-based allogenic hematopoetic stem cell transplants. Bone Marrow Transplant. 2013;48(1):99-104. doi: 10.1038/bmt.2012.115.
33 . Nguyen DT, Shayani S, Palmer J, et al. Palifermin for prevention of oral mucositis in allogeneic hematopoietic stem cell transplantation: A single-ınstitution retrospective evaluation. Support Care Cancer. 2015;23(11):3141-7. doi: 10.1007/s00520-015-2688-7.
34 . Jahangard-Rafsanjani Z, Gholami K, Hadjibabaie M, et al. The ef cacy of selenium in prevention of oral mucositis in patients undergoing hematopoietic SCT: A randomized clinical trial. Bone Marrow Transplantation. 2013;48:832-6. doi: 10.1038/bmt.2012.250.