AI Article Synopsis

  • The study investigates the risk of severe oral mucositis (SOM) in patients undergoing graft-versus-host disease (GVHD) prophylaxis during hematopoietic cell transplantation, focusing on methotrexate (MTX) versus other agents.
  • Using a thorough analysis of published studies, researchers found that patients on MTX or MTX-inclusive regimens had a significantly higher risk of SOM compared to those receiving non-MTX treatments.
  • The findings suggest that alternatives like mycophenolate mofetil (MMF), folinic acid (FA), and lower doses of MTX may reduce the severity of mucositis, highlighting a need for more randomized controlled trials (RCTs) on MTX to optimize patient

Article Abstract

Purpose: This study examines the risk of severe oral mucositis (SOM) in graft-versus-host disease prophylaxis (GVHD) compared to other agents in hematopoietic cell transplantation patients.

Methods: A comprehensive search of four databases, including PubMed, Embassy, Web of Science, and Scopus, was conducted to identify studies reporting frequency and severity of oral mucositis in association with GVHD prophylactic regimens. RevMan 5.4 was used to perform the meta-analysis. Risk of bias assessment was carried out using the Rob-2 tool for randomized clinical trials (RCTs) and ROBINS-I tool for observational studies.

Results: Twenty-five papers, including 11 RCTs and 14 observational studies, met the inclusion criteria. The pooled results from eight RCTs showed a higher risk of SOM in patients receiving MTX or MTX-inclusive GVHD prophylaxis versus non-MTX alternatives (RR = 1.50, 95% CI [1.20, 1.87], I = 36%, P = 0.0003). Mycophenolate mofetil (MMF) and post-transplant cyclophosphamide (Pt-Cy) consistently showed lower risk of mucositis than MTX. Folinic acid (FA) rescue and mini-dosing of MTX were associated with reduced oral mucositis severity.

Conclusion: Patients receiving MTX have a higher SOM risk compared to other approaches to prevent GVHD, which should be considered in patient care. When appropriate, MMF, FA, and a mini-dose of MTX may be an alternative that is associated with less SOM. This work also underlines the scarcity of RCTs on MTX interventions to provide the best evidence-based recommendations.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11255043PMC
http://dx.doi.org/10.1007/s00520-024-08722-wDOI Listing

Publication Analysis

Top Keywords

oral mucositis
16
risk severe
8
severe oral
8
agents hematopoietic
8
hematopoietic cell
8
cell transplantation
8
patients receiving
8
receiving mtx
8
mtx
6
mucositis
5

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!