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mouth ulcers after stem cell transplant
Can anyone recommend ways of preventing or alleviating oral ulcers (mucositis) while recovering from a stem cell transplant? Thanks for your help!!
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Lydia
Re: mouth ulcers after stem cell transplant
Dr. Jacob Laubach from the Dana-Farber Cancer Institute said:
"Oral ulcers are a relatively common phenomenon in the setting of stem cell transplantation for multiple myeloma.
The underlying mechanism is related to chemotherapy-associated mucosal injury with ulceration. The lesions are typically quite painful and can lead to diminished intake of food as well as other complications such as infection. They are usually self-limited, meaning they gradually disappear as the chemotherapy is cleared and the mucosal tissue heals.
There may be a relationship between poor dental hygiene and the development of mucositis, although certainly individuals wtih very good dental hygiene can also experience this problem. Prior to undergoing stem cell transplantation, it is important to undergo a thorough, comprehensive dental evaluation, wtih attention paid to the possibility of both cavities and periodontal disease. Tooth extraction can be considered for patients with severe periodontal disease. All patients should maintain good oral hygiene during the transplant period. We typically recommend regular use of the topical antibiotic solution chlorhexadine.
Pain control is a critical aspect of care for oral ulcers, and the treating physician will regularly evaluate the degree of pain occurring in the setting of chemotherapy-induced mucositis and treat accordingly.
When mucositis is severe enough to prevent oral intake of food, total parenteral (or IV) nutrition may be required, although this is rarely required in myeloma patients undergoing autologous stem cell transplantation."
"Oral ulcers are a relatively common phenomenon in the setting of stem cell transplantation for multiple myeloma.
The underlying mechanism is related to chemotherapy-associated mucosal injury with ulceration. The lesions are typically quite painful and can lead to diminished intake of food as well as other complications such as infection. They are usually self-limited, meaning they gradually disappear as the chemotherapy is cleared and the mucosal tissue heals.
There may be a relationship between poor dental hygiene and the development of mucositis, although certainly individuals wtih very good dental hygiene can also experience this problem. Prior to undergoing stem cell transplantation, it is important to undergo a thorough, comprehensive dental evaluation, wtih attention paid to the possibility of both cavities and periodontal disease. Tooth extraction can be considered for patients with severe periodontal disease. All patients should maintain good oral hygiene during the transplant period. We typically recommend regular use of the topical antibiotic solution chlorhexadine.
Pain control is a critical aspect of care for oral ulcers, and the treating physician will regularly evaluate the degree of pain occurring in the setting of chemotherapy-induced mucositis and treat accordingly.
When mucositis is severe enough to prevent oral intake of food, total parenteral (or IV) nutrition may be required, although this is rarely required in myeloma patients undergoing autologous stem cell transplantation."
Re: mouth ulcers after stem cell transplant
Hi Lydia.
Ask your doctor about the drug "KEPIVANCE".
Kepivance is used to reduce the chance of developing sores and ulcers in the mouth and to shorten the time with sores or ulcers in patients with blood cancers who receive high doses of chemotherapy and radiation therapy before bone marrow transplants.
http://nononan.blogspot.com/2009/06/our-medical-calendar.html
In theory, this sounds good. However, Dom's entire esophagus, as well as his bowels, were torn up from the total body radiation.
http://nononan.blogspot.com/2009/07/radiation-is-bitch.html
http://nononan.blogspot.com/2009/07/have-i-mentioned-that-radiation-is.html
Luckily (???) they kept him higher than a kite. He "lost" much of this, which I'm thankful for.
Anyway, I hope that if nothing else, this info will open up an honest dialog with your doctor. COMMUNICATION is important!
Ask your doctor about the drug "KEPIVANCE".
Kepivance is used to reduce the chance of developing sores and ulcers in the mouth and to shorten the time with sores or ulcers in patients with blood cancers who receive high doses of chemotherapy and radiation therapy before bone marrow transplants.
http://nononan.blogspot.com/2009/06/our-medical-calendar.html
In theory, this sounds good. However, Dom's entire esophagus, as well as his bowels, were torn up from the total body radiation.
http://nononan.blogspot.com/2009/07/radiation-is-bitch.html
http://nononan.blogspot.com/2009/07/have-i-mentioned-that-radiation-is.html
Luckily (???) they kept him higher than a kite. He "lost" much of this, which I'm thankful for.
Anyway, I hope that if nothing else, this info will open up an honest dialog with your doctor. COMMUNICATION is important!
-
Nanette - Name: Nanette "Deaux"
- Who do you know with myeloma?: My dear husband, Dominic
- When were you/they diagnosed?: Spring of 2008
- Age at diagnosis: 62
Re: mouth ulcers after stem cell transplant
Thanks Dr. Laubach for answering my question, and thanks Nan for sharing about Dom's experience with mucositis, though I'm sorry to hear he had such a horrible case of it.
Actually, there's a recent study about Kepivance. It shows that a 3-day treatment with Kepivance shortens the hospital stay after transplantation (18 vs 22-days).
This study is looking at a shortened treatment course for Kepivance. The normal regimen is a 6-day course. Therefore, I'm curious. How does this 3-day course compare to the standard 6-day course?
I found more about the standard course on www.kepivance.com
It looks like the studies that they report on the drug's webpage are for patients with blood cancers in general, not specific to myeloma patients. However, if it's reasonable to compare this recent study about the 3-day course with results from the 6-day course, it looks like severe mucositis is experienced in 98% of patients without medication, 63% of patients on the 6-day Kepivance regimen, and only 24% of patients on the 3-day Kepivance regimen. That's impressive. I would have expected side effects to go down with the shorter treatment, but I'm a bit surprised that it also seems to be more effective. But maybe it's not fair to directly compare these numbers. Maybe the blood cancer group went through more intense chemotherapy.
Anyway, good thing to keep in mind at the next doctor's appointment!
Actually, there's a recent study about Kepivance. It shows that a 3-day treatment with Kepivance shortens the hospital stay after transplantation (18 vs 22-days).
This study is looking at a shortened treatment course for Kepivance. The normal regimen is a 6-day course. Therefore, I'm curious. How does this 3-day course compare to the standard 6-day course?
I found more about the standard course on www.kepivance.com
It looks like the studies that they report on the drug's webpage are for patients with blood cancers in general, not specific to myeloma patients. However, if it's reasonable to compare this recent study about the 3-day course with results from the 6-day course, it looks like severe mucositis is experienced in 98% of patients without medication, 63% of patients on the 6-day Kepivance regimen, and only 24% of patients on the 3-day Kepivance regimen. That's impressive. I would have expected side effects to go down with the shorter treatment, but I'm a bit surprised that it also seems to be more effective. But maybe it's not fair to directly compare these numbers. Maybe the blood cancer group went through more intense chemotherapy.
Anyway, good thing to keep in mind at the next doctor's appointment!
-
Lydia
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