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Supportive Care in Cancer

, Volume 27, Issue 3, pp 839–848 | Cite as

Retrospective study of the digestive tract mucositis derived from myeloablative and non-myeloablative/reduced-intensity conditionings with busulfan in hematopoietic cell transplantation patient

  • Fernanda P. EduardoEmail author
  • Leticia Mello Bezinelli
  • Marcella Gobbi
  • Flavia C. P. Rosin
  • Danielle L. C. Carvalho
  • Mariana Henriques Ferreira
  • Cinthya Correa da Silva
  • Nelson Hamerschlak
  • Luciana Corrêa
Original Article

Abstract

Busulfan is a major component of chemotherapy conditioning in hematopoietic cell transplantation (HCT). This alkylating agent is highly toxic at myeloablative doses, exposing HCT patients to risks of mortality. Non-myeloablative (NMA) and reduced-intensity conditioning (RIC) using busulfan have shown impaired toxicity. However, the toxicity of NMA/RIC in the digestive tract is poorly described. This study aimed to characterize the mucositis in the oral cavity (OM), oropharynx/esophagus, and gastrointestinal tract derived from conditionings with myeloablative and non-myeloablative doses of busulfan. We retrospectively retrieved clinical data of HCT patients (n = 100) who underwent myeloablative conditioning (MAC) or NMA/RIC with busulfan. Frequency and time duration of mucositis in the oral cavity and oropharynx/esophagus, diarrhea, and prescription of total parenteral nutrition (TPN) and opioids were also collected. OM severity (p = 0.009) and time duration of mucositis in oropharynx/esophagus (p = 0.022) were frequently higher in MAC than NMA/RIC. A myeloablative dose of busulfan was a risk factor for OM grade ≥ 2 (OR = 4.8, p = 0.002) and for mucositis in oropharynx/esophagus ≥ 5 days (OR = 2.64, p = 0.035). A longer duration of mucositis in the oropharynx/esophagus was also associated with an increase in the prescription of opioids (OR = 7.10, p < 0.001).Overall survival (OS) in MAC was significantly higher than that in NMA/RIC (p = 0.017). No variables related to mucositis interfere significantly in OS. In conclusion, myelosuppression in busulfan-based regimens are predisposed to a high risk for severe OM and to prolonged mucositis in the oropharynx/esophagus.

Keywords

Oral mucositis Gastrointestinal mucositis Hematopoietic cell transplantation Busulfan 

Notes

Funding information

We thank the São Paulo Research Foundation (FAPESP, Proc. no. 2016/03650–4) and AmigoH for their financial support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Fernanda P. Eduardo
    • 1
    Email author
  • Leticia Mello Bezinelli
    • 1
  • Marcella Gobbi
    • 1
  • Flavia C. P. Rosin
    • 1
  • Danielle L. C. Carvalho
    • 1
    • 2
  • Mariana Henriques Ferreira
    • 1
    • 2
  • Cinthya Correa da Silva
    • 1
  • Nelson Hamerschlak
    • 1
  • Luciana Corrêa
    • 2
  1. 1.Hematology/Oncology of Hospital Israelita Albert Einstein_HIAESão PauloBrazil
  2. 2.General Pathology Department, School of DentistryUniversity of São PauloSao PauloBrazil

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