Risk Factors of Grazziutti et al for Severe Oral Mucositis in a Patient Undergong Melphalan-Based Autologous Stem Cell Transplant for Myeloma

 

Patient selection: myeloma with autologous stem cell transplant following melphalan therapy

 

The dose of melphalan was 200 mg per square meter body surface area, with the body surface area calculated using a calculated body weight that corrected for obesity.

 

Risk factors for severe oral mucositis (Grades 3 or 4):

(1) melphalan dose > 3.4 mg per kg actual body weight

(2) elevated serum creatinine (reduced creatinine clearance)

Dose in mg per kg actual body weight	Percent Severe Oral Mucositis
<= 3.4	4%
3.5 to 4.4	17%
> 4.4	24%

 

The higher values in dose per actual weight were seen in patients with a body weight less than 90 kilograms. This group is also at higher risk for myelosuppression.

 

Interestingly the rate of no oral mucositis was constant at 25% no matter what the dose. Some patients have Grade 1 or 2 oral mucositis even at lower doses.