Pharmacological correction of various morphological forms of oral mucositis in patients with leukemia
Oral mucositis (OM) is a common complication against the background of modern leukemia therapy, which significantly impairs patients’ quality of life. The purpose of the study was to evaluate the effectiveness of the use of local Cyanocobalamin and Decamethoxine therapy for the prevention and treatment of OM. The study was conducted on the basis of the hematology department of Vinnytsia Regional Clinical Hospital n.a. M.I. Pirogov in 2013-2019 (58 patients were studied with standard combination chemotherapy with Cytarabine, Methotrexate and anthracycline antibiotics). In addition to the standard clinical and laboratory study, dental examination was performed before treatment, at 7 and 14 days of treatment with determination of the degree of mucositis according to the NCI-CTC criteria and determination of quality of life indicators. At the same time, a sample incisional biopsy of the oral mucosa was performed with photo-fixation of histopreparations. In a group of 28 patients, 7 days orally administered a combination of Septefril (Decamethoxine) 0.2 mg 4-6 times daily, and Cyanocobalamin 500 mg 3 times daily. Statistical processing of the obtained results was carried out in the license package “STATISTICA 6.1” using non-parametric methods of evaluation of the obtained results. Prior to the onset of cytostatic therapy, no signs of inflammatory lesions were reported. However, patients with pre-established signs of caries, periodontal disease and lack of teeth subsequently experienced OM, even with the use of Cyanocobalamin and Septefril. Thus, after 7 days in 8 patients on the background of medication correction I-II degree of OM according to NCI-CTC was recorded, and only in 2 – III degree, unlike the group without correction. In the group where this combination of drugs was used, OM was recorded after 7 days in 12 patients, in contrast to the indices where the correction was not performed and the development of OM had a more pronounced course and was present in all patients. According to the morphological study, several degrees of OM were observed in patients. Initially, catarrhal stomatitis with pronounced plethora and swelling of the mucous membrane was detected. During the transition to the second stage of mucositis, the aphthous stomatitis was morphologically observed, as well as dead epithelial cells and the cells undergoing parakeratotic transformation. After the application of the proposed therapy, erosion remained after the film rejection, which recovered without scarring. Thus, cytostatic therapy in patients with leukemia always causes manifestations of OM, which are more pronounced in patients with concomitant risk factors. The use of a combination of Cyanocobalamin and Septefril significantly reduces the manifestation of OM and improves the quality of life of patients against cytostatic therapy.
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