The Prevention of Oral Mucositis in Patients with Blood Cancers: Current Concepts and Emerging Landscapes

Pasquale      Niscola; Andrea      Tendas; Luca      Cupelli; Gianfranco      Catalano; Laura      Scaramucci; Marco      Giovannini; Vito      Trinchieri; Atul      Sharma; Fabio      Efficace; Claudio      Cartoni; Daniela      Piccioni; Alessio      Perrotti; Teresa      Dentamaro; Paolo      de Fabritiis; Dorothy      M.K. Keefe

Abstract

Background. The prevention of oral mucositis (OM) in the management of hematological malignancies continues to represent an unmet clinical need. Addressing this issue has major clinical implications as OM can also greatly impair patient’s quality of life. Objectives. To review currently available measures and investigational agents to prevent OM in hematological patients. Methods: we searched for OM and related issues using Medline; the abstract books of the most important hematological and oncological meetings were also reviewed. Results/Conclusions. Many agents targeting different mechanisms of mucosal damage have been applied in order to prevent OM; most of them have failed or its efficacy has not been fully demonstrated. Palifermin is the first pharmaceutical/biological agent approved for the prevention of OM; its use is currently restricted to patients who have received radiotherapy-containing conditioning regimens prior to autologous hematopoietic stem cell transplantation. No clear benefit by this agent has been demonstrated outside of this specific setting and its application should be limited to clinical trials. Other interventions, such as other growth factors and non mitogenic measures are under investigation or in development and their application in the hematological setting is expected in the short term.

Keywords: Antineoplastic treatments, chemotherapy, hematology, hematopoietic stem cell transplantation, Lactobacillus brevis CD2, leukemia, lymphoma, multiple myeloma, mucositis, oral cavity, palifermin, prevention, radiotherapy, stomatitis