Mucositis after Reduced Intensity Conditioning and Allogeneic Stem Cell Transplantation

Background: Therapy-related mucositis is associated with considerable morbidity. This complication following allogeneic stem cell therapy (allo-SCT) is less severe after reduced intense conditioning (RIC); however, even here it may be serious. Methods: 52 patients (male: n = 35 (67%), female: n = 17 (33%)) at a median age of 62 years (35-73 years) underwent allo-SCT after RIC. Conditioning was either total body irradiation (TBI)(2Gy)/+/- fludarabine (n = 33, 63.5%) or chemotherapy based. Graft-versus-host disease (GvHD) prophylaxis was carried out with cyclosporine A +/- mycophenolate mofetil (MMF). 45 patients (87%) received short-course methotrexate (MTX). Mucositis was graded according to the Bearman and the World Health Organisation (WHO) scale. A variety of parameters were correlated with mucositis. Results: The Bearman and WHO scales showed excellent correlation. Mucositis was significantly more severe after chemotherapy-based conditioning compared to conditioning with TBI(2Gy)/+/- fludarabine (p < 0.002) as well as in cases with an increase in creatinine levels above the upper normal value (UNV) on day + 1 after SCT (p < 0.05). Furthermore, the severity correlated with time to engraftment of leucocytes (correlation coefficient (cc) = 0.26, p < 0.02) and thrombocytes (cc = 0.38, p < 0.001). Conclusions: The conditioning regimen and increased creatinine levels at day + 1 were identified as factors predicting the severity of mucositis after RIC-SCT. Creatinine levels on day + 1 after SCT may help identify patients at risk for severe mucositis in the further course of transplantation.