Analysis of factors that correlate with mucositis in recipients of autologous and allogeneic stem-cell transplants

Purpose: To identify predictors of aral mucositis and gastrointestinal toxi city after high-dose therapy. Patients and Methods: Mucositis and gastrointestinal toxicity were prospect ively evaluated in 202 recipients of high-dose therapy and autologous or al logeneic stem-cell rescue. Of 10 outcome variables, three were selected as end points: the peak value for the University of Nebraska Oral Assessment S core (MUCPEAK), the duration of parenteral nutritional support, and the pea k daily output of diarrhea. Potential covariates included patient age, sex, diagnosis, treatment protocol, transplantation type, stem-cell source, and rate of neutrophil recovery. The three selected end points were also exami ned for correlation with blood infections and transplant-related mortality. Results: A diagnosis of leukemia, use of total body irradiation, allogeneic transplantation, and delayed neutrophil recovery were associated with incr eased oral mucositis and longer parenteral nutritional support. No factors were associated with diarrhea. Also, moderate to severe oral mucositis (MUC PEAK greater than or equal to 18 on a scale of 8 to 24) was correlated with blood infections and transplant-related mortality: 60% of patients with MU CPEAK greater than or equal to 18 had positive blood cultures versus 30% of patients with MUCPEAK less than 18 (P = .001); 24% of patients with MUCPEA K greater than or equal to 18 died during the transplantation procedure ver sus 4% of patients with MUCPEAK less than 18 (P = .001). Conclusion: Gastrointestinal toxicity is a major cause of transplant-relate d morbidity and mortality, emphasising the need for corrective strategies. The peak oral mucositis scare and the duration of parenteral nutritional su pport are useful indices of gastrointestinal toxicity because these end poi nts are correlated with clinically significant events, including blood infe ctions and treatment-related mortality. (C) 1999 by American Society of Cli nical Oncology.