A LONGITUDINAL-STUDY OF ORAL ULCERATIVE MUCOSITIS IN BONE-MARROW TRANSPLANT RECIPIENTS

Background. Few longitudinal studies have investigated the onset, dura tion, and resolution of ulcerative mucositis in bone marrow transplant recipients. This study prospectively followed a group of such patient s on a daily basis to obtain data on the incidence of ulcerative mucos itis, location and duration of lesions, severity with different condit ioning regimens, and the relationship of such mucositis to the absolut e neutrophil count. Methods. Fifty-nine bone marrow transplant recipie nts on prophylactic acyclovir were examined daily for 26 days after ma rrow infusion, and all oral ulcerative lesions were recorded. Results. Oral ulcers occurred in 76.3% of patients, began at a mean of 5 days after marrow infusion (day + 5), and lasted for a median of 6 days. Mo re than 90% of patients showed complete resolution of ulcers on or bef ore day + 15, and all showed resolution when the absolute neutrophil c ount was > 500 cells/ml. Persistence of ulcers was noticed in patients who had oral graft-versus-host disease and in some patients who initi ally developed more severe ulcerations. Ninety-six percent of ulcers w ere located on nonkeratinized mucosa. Conclusions. Ulcerative mucositi s occurs in about 75% of bone marrow transplant recipients in the abse nce of herpes simplex virus infection. Most lesions occur on nonkerati nized mucosae which are vulnerable to trauma, especially if such mucos ae are rendered atrophic by conditioning regimens. Oral ulcers may per sist beyond day + 15 and after recovery of the neutrophil count in pat ients who initially develop more severe ulcerations or in patients who develop graft-versus-host disease.