THE ACUTE CLINICAL AND LABORATORY CONSEQUENCES OF ORAL MUCOSITIS DEVELOPED AFTER REMISSION INDUCTION CHEMOTHERAPY IN ACUTE LEUKEMIA PATIENTS
(Abstract release date: 05/19/16)
EHA Library. Guler N. 06/09/16; 134576; PB1676
Assoc. Prof. Nil Guler
Contributions
Contributions
Abstract
Abstract: PB1676
Type: Publication Only
Background
Chemotherapeutic (CT) agents frequently cause oral mucositis (OM) as a side effect during the treatment of acute leukemia. Patients with OM are generally more predisposed to intraoral infections. OM also affects the nutrition, swallowing, and quality of life.
Aims
To analyze the consequences of post chemotherapy developed OM in acute leukemia patients.
Methods
Seventy-two adult patients with newly-diagnosed Acute Myeloblastic leukemia (n=59), Acute Lymphoblastic Leukemia (n=13) were included. CTs were 7+3 ARA-C+ idarubicin (n=43), Azacitidine (n=13), idarubicin +ATRA (n=2), low dose ARA-C (n=1), Hyper-CVAD (n=8), CALGB (n=5). Patients divided into two groups as post-chemotherapy OM or not. Evaluation was performed by same physician daily according to WHO (World Health Organization) OM classification. Stage 1: Oral soreness, erythema; stage 2: Oral erythema, ulcers, solid diet tolerated; stage 3: Oral ulcers, liquid diet only; stage 4: Oral alimentation impossible.
Results
OM occurred in 27 (37%) of 72 patients. Appearance time of the OM after the initiation day of the CT was 6.3 ± 3.4 days and OM were continued for 9.7 ± 5.8 days. There were no significant differences in sociodemographic data, type of leukemia, CT protocol, and smoking status between the two groups. Mostly OM were stage 2 (40.7%, n=11). Others were stage 1 (14%, n=4), stage 3 (29.6%, n=8), stage 4 (14.8%, n=4).Microorganisms in the oral mucositis swab cultures were detected in 12 out of 27 patients with OM. They were Pseudomonas aeruginosa (n=4 patient, 14.8%), Streptococcus viridans in (n=2; 7.4%), Enteroccus faecium in (n=2), Candia albicans (n=1; 3.7%), Acinetobacter baumannii (n=1), Morganella morganii (n=1), Enterobacter cloacae (n=1). Microorganisms in blood cultures of patients with OM were detected in 7 (25.9%) out of 27 patients. This ratio was low as 11% (5 out of 45) in patients without OM. There wasn’t any relationship between microorganism in swab culture and blood culture as same in patients.Microorganism in blood cultures of patients with OM were: Staphylococcus hominis (n=2 patients, 7.4%), ESBL Negative E.coli (n=2; 7.4%), Acinetobacter baumannii (n=1; 3.7%), Staphylococcus Epidermidis (n=1), Coagulase negative staphylococcus (n=1). Microorganisms in blood cultures of patients without OM were such as: Staphylococcus Epidermidis (n=2; 4.4%), ESBL Negative E.coli (n=1; 2.2%), Staphylococcus capitis (n=1), Staphylococcus hominis (n=1).The mean duration of neutropenia in OM group was 32 days compared to 22 days in the without OM group (p=0.02). The pre-treatment level of serum albumin was lower, and the levels of CRP and LDH during mucositis were higher in the patients with OM (p<0.001, p<0.001and p=0.002, respectively). Mortality was higher in the group with OM, 9 (6 patients with stage 3 or 4 OM; 3 patients with stage 1) in 27 vs 6 in 45 patients (p=0.04). Six of 12 patients who developed severe mucositis (stages 3 and 4) died. The fever appeared on day 7.1± 0.87 of the CT in the patients with OM, whereas fever was observed on day 4.1±0.67 in the patients without OM (p=0.002).
Conclusion
The development of OM may have a role about prognostic value in the patients receiving CT because of the extended duration of neutropenia, higher levels of LDH and CRP, and a higher rate of mortality in patients with OM. Furthermore, we would like to highlight that the patients with low levels of albumin prior to chemotherapy should be more closely followed for OM.
Session topic: E-poster
Keyword(s): Acute leukemia, Chemotherapy, Oral
Type: Publication Only
Background
Chemotherapeutic (CT) agents frequently cause oral mucositis (OM) as a side effect during the treatment of acute leukemia. Patients with OM are generally more predisposed to intraoral infections. OM also affects the nutrition, swallowing, and quality of life.
Aims
To analyze the consequences of post chemotherapy developed OM in acute leukemia patients.
Methods
Seventy-two adult patients with newly-diagnosed Acute Myeloblastic leukemia (n=59), Acute Lymphoblastic Leukemia (n=13) were included. CTs were 7+3 ARA-C+ idarubicin (n=43), Azacitidine (n=13), idarubicin +ATRA (n=2), low dose ARA-C (n=1), Hyper-CVAD (n=8), CALGB (n=5). Patients divided into two groups as post-chemotherapy OM or not. Evaluation was performed by same physician daily according to WHO (World Health Organization) OM classification. Stage 1: Oral soreness, erythema; stage 2: Oral erythema, ulcers, solid diet tolerated; stage 3: Oral ulcers, liquid diet only; stage 4: Oral alimentation impossible.
Results
OM occurred in 27 (37%) of 72 patients. Appearance time of the OM after the initiation day of the CT was 6.3 ± 3.4 days and OM were continued for 9.7 ± 5.8 days. There were no significant differences in sociodemographic data, type of leukemia, CT protocol, and smoking status between the two groups. Mostly OM were stage 2 (40.7%, n=11). Others were stage 1 (14%, n=4), stage 3 (29.6%, n=8), stage 4 (14.8%, n=4).Microorganisms in the oral mucositis swab cultures were detected in 12 out of 27 patients with OM. They were Pseudomonas aeruginosa (n=4 patient, 14.8%), Streptococcus viridans in (n=2; 7.4%), Enteroccus faecium in (n=2), Candia albicans (n=1; 3.7%), Acinetobacter baumannii (n=1), Morganella morganii (n=1), Enterobacter cloacae (n=1). Microorganisms in blood cultures of patients with OM were detected in 7 (25.9%) out of 27 patients. This ratio was low as 11% (5 out of 45) in patients without OM. There wasn’t any relationship between microorganism in swab culture and blood culture as same in patients.Microorganism in blood cultures of patients with OM were: Staphylococcus hominis (n=2 patients, 7.4%), ESBL Negative E.coli (n=2; 7.4%), Acinetobacter baumannii (n=1; 3.7%), Staphylococcus Epidermidis (n=1), Coagulase negative staphylococcus (n=1). Microorganisms in blood cultures of patients without OM were such as: Staphylococcus Epidermidis (n=2; 4.4%), ESBL Negative E.coli (n=1; 2.2%), Staphylococcus capitis (n=1), Staphylococcus hominis (n=1).The mean duration of neutropenia in OM group was 32 days compared to 22 days in the without OM group (p=0.02). The pre-treatment level of serum albumin was lower, and the levels of CRP and LDH during mucositis were higher in the patients with OM (p<0.001, p<0.001and p=0.002, respectively). Mortality was higher in the group with OM, 9 (6 patients with stage 3 or 4 OM; 3 patients with stage 1) in 27 vs 6 in 45 patients (p=0.04). Six of 12 patients who developed severe mucositis (stages 3 and 4) died. The fever appeared on day 7.1± 0.87 of the CT in the patients with OM, whereas fever was observed on day 4.1±0.67 in the patients without OM (p=0.002).
Conclusion
The development of OM may have a role about prognostic value in the patients receiving CT because of the extended duration of neutropenia, higher levels of LDH and CRP, and a higher rate of mortality in patients with OM. Furthermore, we would like to highlight that the patients with low levels of albumin prior to chemotherapy should be more closely followed for OM.
Session topic: E-poster
Keyword(s): Acute leukemia, Chemotherapy, Oral
Abstract: PB1676
Type: Publication Only
Background
Chemotherapeutic (CT) agents frequently cause oral mucositis (OM) as a side effect during the treatment of acute leukemia. Patients with OM are generally more predisposed to intraoral infections. OM also affects the nutrition, swallowing, and quality of life.
Aims
To analyze the consequences of post chemotherapy developed OM in acute leukemia patients.
Methods
Seventy-two adult patients with newly-diagnosed Acute Myeloblastic leukemia (n=59), Acute Lymphoblastic Leukemia (n=13) were included. CTs were 7+3 ARA-C+ idarubicin (n=43), Azacitidine (n=13), idarubicin +ATRA (n=2), low dose ARA-C (n=1), Hyper-CVAD (n=8), CALGB (n=5). Patients divided into two groups as post-chemotherapy OM or not. Evaluation was performed by same physician daily according to WHO (World Health Organization) OM classification. Stage 1: Oral soreness, erythema; stage 2: Oral erythema, ulcers, solid diet tolerated; stage 3: Oral ulcers, liquid diet only; stage 4: Oral alimentation impossible.
Results
OM occurred in 27 (37%) of 72 patients. Appearance time of the OM after the initiation day of the CT was 6.3 ± 3.4 days and OM were continued for 9.7 ± 5.8 days. There were no significant differences in sociodemographic data, type of leukemia, CT protocol, and smoking status between the two groups. Mostly OM were stage 2 (40.7%, n=11). Others were stage 1 (14%, n=4), stage 3 (29.6%, n=8), stage 4 (14.8%, n=4).Microorganisms in the oral mucositis swab cultures were detected in 12 out of 27 patients with OM. They were Pseudomonas aeruginosa (n=4 patient, 14.8%), Streptococcus viridans in (n=2; 7.4%), Enteroccus faecium in (n=2), Candia albicans (n=1; 3.7%), Acinetobacter baumannii (n=1), Morganella morganii (n=1), Enterobacter cloacae (n=1). Microorganisms in blood cultures of patients with OM were detected in 7 (25.9%) out of 27 patients. This ratio was low as 11% (5 out of 45) in patients without OM. There wasn’t any relationship between microorganism in swab culture and blood culture as same in patients.Microorganism in blood cultures of patients with OM were: Staphylococcus hominis (n=2 patients, 7.4%), ESBL Negative E.coli (n=2; 7.4%), Acinetobacter baumannii (n=1; 3.7%), Staphylococcus Epidermidis (n=1), Coagulase negative staphylococcus (n=1). Microorganisms in blood cultures of patients without OM were such as: Staphylococcus Epidermidis (n=2; 4.4%), ESBL Negative E.coli (n=1; 2.2%), Staphylococcus capitis (n=1), Staphylococcus hominis (n=1).The mean duration of neutropenia in OM group was 32 days compared to 22 days in the without OM group (p=0.02). The pre-treatment level of serum albumin was lower, and the levels of CRP and LDH during mucositis were higher in the patients with OM (p<0.001, p<0.001and p=0.002, respectively). Mortality was higher in the group with OM, 9 (6 patients with stage 3 or 4 OM; 3 patients with stage 1) in 27 vs 6 in 45 patients (p=0.04). Six of 12 patients who developed severe mucositis (stages 3 and 4) died. The fever appeared on day 7.1± 0.87 of the CT in the patients with OM, whereas fever was observed on day 4.1±0.67 in the patients without OM (p=0.002).
Conclusion
The development of OM may have a role about prognostic value in the patients receiving CT because of the extended duration of neutropenia, higher levels of LDH and CRP, and a higher rate of mortality in patients with OM. Furthermore, we would like to highlight that the patients with low levels of albumin prior to chemotherapy should be more closely followed for OM.
Session topic: E-poster
Keyword(s): Acute leukemia, Chemotherapy, Oral
Type: Publication Only
Background
Chemotherapeutic (CT) agents frequently cause oral mucositis (OM) as a side effect during the treatment of acute leukemia. Patients with OM are generally more predisposed to intraoral infections. OM also affects the nutrition, swallowing, and quality of life.
Aims
To analyze the consequences of post chemotherapy developed OM in acute leukemia patients.
Methods
Seventy-two adult patients with newly-diagnosed Acute Myeloblastic leukemia (n=59), Acute Lymphoblastic Leukemia (n=13) were included. CTs were 7+3 ARA-C+ idarubicin (n=43), Azacitidine (n=13), idarubicin +ATRA (n=2), low dose ARA-C (n=1), Hyper-CVAD (n=8), CALGB (n=5). Patients divided into two groups as post-chemotherapy OM or not. Evaluation was performed by same physician daily according to WHO (World Health Organization) OM classification. Stage 1: Oral soreness, erythema; stage 2: Oral erythema, ulcers, solid diet tolerated; stage 3: Oral ulcers, liquid diet only; stage 4: Oral alimentation impossible.
Results
OM occurred in 27 (37%) of 72 patients. Appearance time of the OM after the initiation day of the CT was 6.3 ± 3.4 days and OM were continued for 9.7 ± 5.8 days. There were no significant differences in sociodemographic data, type of leukemia, CT protocol, and smoking status between the two groups. Mostly OM were stage 2 (40.7%, n=11). Others were stage 1 (14%, n=4), stage 3 (29.6%, n=8), stage 4 (14.8%, n=4).Microorganisms in the oral mucositis swab cultures were detected in 12 out of 27 patients with OM. They were Pseudomonas aeruginosa (n=4 patient, 14.8%), Streptococcus viridans in (n=2; 7.4%), Enteroccus faecium in (n=2), Candia albicans (n=1; 3.7%), Acinetobacter baumannii (n=1), Morganella morganii (n=1), Enterobacter cloacae (n=1). Microorganisms in blood cultures of patients with OM were detected in 7 (25.9%) out of 27 patients. This ratio was low as 11% (5 out of 45) in patients without OM. There wasn’t any relationship between microorganism in swab culture and blood culture as same in patients.Microorganism in blood cultures of patients with OM were: Staphylococcus hominis (n=2 patients, 7.4%), ESBL Negative E.coli (n=2; 7.4%), Acinetobacter baumannii (n=1; 3.7%), Staphylococcus Epidermidis (n=1), Coagulase negative staphylococcus (n=1). Microorganisms in blood cultures of patients without OM were such as: Staphylococcus Epidermidis (n=2; 4.4%), ESBL Negative E.coli (n=1; 2.2%), Staphylococcus capitis (n=1), Staphylococcus hominis (n=1).The mean duration of neutropenia in OM group was 32 days compared to 22 days in the without OM group (p=0.02). The pre-treatment level of serum albumin was lower, and the levels of CRP and LDH during mucositis were higher in the patients with OM (p<0.001, p<0.001and p=0.002, respectively). Mortality was higher in the group with OM, 9 (6 patients with stage 3 or 4 OM; 3 patients with stage 1) in 27 vs 6 in 45 patients (p=0.04). Six of 12 patients who developed severe mucositis (stages 3 and 4) died. The fever appeared on day 7.1± 0.87 of the CT in the patients with OM, whereas fever was observed on day 4.1±0.67 in the patients without OM (p=0.002).
Conclusion
The development of OM may have a role about prognostic value in the patients receiving CT because of the extended duration of neutropenia, higher levels of LDH and CRP, and a higher rate of mortality in patients with OM. Furthermore, we would like to highlight that the patients with low levels of albumin prior to chemotherapy should be more closely followed for OM.
Session topic: E-poster
Keyword(s): Acute leukemia, Chemotherapy, Oral
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