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Mucositis is a frequent severe complication associated to aggressive therapies of hematological malignancies with chemo and/or radiation (therapy), conditioning therapy in stem cell transplants. Regularly occurs at 3 to 10 days after chemotherapy and about 6 to 8 weeks after radiotherapy. It is self-limited within 2-4 weeks, but in this period the patient is vulnerable to systemic infections (bacterial and fungal). It could also compromise the optimal timing and dosage of the chemotherapy schedule, induce psychosocial distress, prolonged hospitalization and finally, higher costs.

A retrospective analysis of 77 adult patients: 17 with hematological treatments and 60 with allogeneic stem cell transplantation. 17 were diagnosed and treated between January 2015 and December 2016 with various hematologic malignances (5 AML, 2 ALL – 1 Ph positive, 2 blastic phases of CML, 3 AILT (CHOP/DA-EPOCH), 2 DLBCL (RCHOP), 1 FL (RCVP), 1 MM (radiotherapy), 1Hodgkin disease (ABVD). Treatment regimens used for acute leukemias/blastic phases of CML were: “3+7” (3 cases), MEC (1 case), high doses ARA-C (1), GMALL protocol (1), HyperCVAD (1), Idarubicine and ARA-C(1) HD-MTX(1) . GelX® was indicated as prophylactic treatment for eight patients, because the risk of mucositis was high (aggressive chemotherapy, bad oral condition, risk of prolonged neutropenia). Curative treatment of grade 3-4 mucositis was indicated for 10 patients (one was initially treated with curative intention and after that with prophylaxis). In 60 patients allografted for various hematological conditions (35 unrelated, 4 haplo and 21 sibling) GelX® was prescribed for treating grade 3-4 mucositis. For the 35 cases with unrelated allotransplant (21 AML, 4 ALL, 2 SA, 2ATLL, 2 MMM, 2 CML, 1 MDS, 1 BH), 16 cases of grade 3-4 mucositis has appeared .The conditioning regimen was mieloablative(14 cases) and reduced intensity( 21 cases) .There were 21 cases of sibling allotransplants (6AML, 3 ALL, 1 ATLL, 5 LMNH, 1CLL, 2 SAA, 2 CML, 1 mycosis)with 10 cases of mucositis grade 3-4. The regimens used were 6 mieloablative and 15 nonmieloablative. 3 from 4 cases of haplotransplant with nonmieloablative conditioning (2MDS, 1 AML and 1 SAA) had grade 3 mucositis.

Prophylaxis is the key of successful evolution in mucositis (time to heal shorter than 10 days). Identifying candidates for mucositis is mandatory and the product should be applied starting with the chemotherapy (or in the first 24 hours on the onset of chemotherapy) in order to minimize the risk of mucositis appearance.