Pharmacological correction of various morphological forms of oral mucositis in patients with leukemia


  • D.A. Lysenko National Pirogov Memorial Medical University, Vinnytsya, Vinnytsia, Ukraine
  • O.I. Lukianovych Vinnitsa Regional Pathoanatomical Bureau, Vinnytsia, Ukraine
  • S.V. Sergyeyev National Pirogov Memorial Medical University, Vinnytsya, Vinnytsia, Ukraine
  • O.A. Bobrowska National Pirogov Memorial Medical University, Vinnytsya, Vinnytsia, Ukraine
  • O.O. Gurova Vinnytsia Regional Clinical Hospital n.a. M.I. Pirogov, Vinnytsia, Ukraine
Keywords: cytostatic therapy, oral mucositis, Septefril, Cyanocobalamin, quality of life, morphological examination.

Abstract

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.

References

[1] Ahmad, P., Akhtar, U., Chaudhry, A., Rashid, U., Saif, S., & Asif, J. A. (2019). Treatment and prevention of oral mucositis: A literature review. European Journal of General Dentistry, 8(2), 23. doi: 10.4103/ejgd.ejgd_30_19

[2] Basile, D., Di Nardo, P., Corvaja, C., Garattini, S. K., Pelizzari, G., Lisanti, C., & Gerratana, L. (2019). Mucosal Injury during Anti-Cancer Treatment: From Pathobiology to Bedside. Cancers, 11(6), 857. https://doi.org/10.3390/cancers11060857

[3] Blakaj, A., Bonomi, M., Gamez, M. E., & Blakaj, D. M. (2019). Oral mucositis in head and neck cancer: Evidence-based management and review of clinical trial data. Oral oncology, 95, 29-34. https://doi.org/10.1016/j.oraloncology.2019.05.013

[4] Bonnetain, F., Fiteni, F., Efficace, F., & Anota, A. (2016). Statistical Challenges in the Analysis of Health-Related Quality of Life in Cancer Clinical Trials. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 34(16), 1953. https://doi.org/10.1200/JCO.2014.56.7974

[5] Bradstock, K. F., Link, E., Collins, M., Di Iulio, J., Lewis, I. D., Schwarer, A., & Cull, G. (2014). A randomized trial of prophylactic palifermin on gastrointestinal toxicity after intensive induction therapy for acute myeloid leukaemia. British journal of haematology, 167(5), 618-625. https:// doi.org/ 10.1111/bjh.13086

[6] Brown, P. A., Wieduwilt, M., Logan, A., DeAngelo, D. J., Wang, E. S., Fathi, A., & Bhatnagar, B. (2019). Guidelines Insights: Acute Lymphoblastic Leukemia, Version 1.2019: Featured Updates to the NCCN Guidelines. Journal of the National Comprehensive Cancer Network, 17(5), 414-423. https://doi.org/10.6004/jnccn.2019.0024

[7] Carrozzo, M., Eriksen, J. G., Bensadoun, R. J., Boers-Doets, C. B., Lalla, R. V., & Peterson, D. E. (2019). Oral Mucosal Injury Caused by Targeted Cancer Therapies. JNCI Monographs, (53), lgz012. https://doi.org/10.1093/jncimonographs/lgz012

[8] Chaveli-López, B., & Bagán-Sebastián, J. V. (2016). Treatment of oral mucositis due to chemotherapy. Journal of clinical and experimental dentistry, 8(2), e201-9. doi: 10.4317/jced.52917

[9] Cidon, E. U. (2017). Chemotherapy induced oral mucositis: prevention is possible. Chinese clinical oncology, 7(1), 6. doi: 10.21037/cco.2017.10.01

[10] Cinausero, M., Aprile, G., Ermacora, P., Basile, D., Vitale, M. G., Fanotto, V., ... & Sonis, S. T. (2017). New Frontiers in the Pathobiology and Treatment of Cancer Regimen-Related Mucosal Injury. Frontiers in pharmacology, 8, 354. doi: 10.3389/fphar.2017.00354

[11] Daugėlaitė, G., Užkuraitytė, K., Jagelavičienė, E., & Filipauskas, A. (2019). Prevention and Treatment of Chemotherapy and Radiotherapy Induced Oral Mucositis. Medicina, 55(2), 25. doi: 10.3390/medicina55020025

[12] Isakova, L. М., & Lysenko, D. А. (2006). Methodology of the quality of life estimation in oncohematology. Ukrainian Medical Journal, 3, 47-50.

[13] Kanagalingam, J., Chopra, A., Hong, M. H., Ibrahim, W., Villalon, A., & Lin, J. C. (2017). Povidone-iodine for the management of oral mucositis during cancer therapy. Oncology reviews, 11(2), 341. doi: 10.4081/oncol.2017.341

[14] Kim, J. W., Kim, M. G., Lee, H. J., Koh, Y., Kwon, J. H., Kim, I., ... & Yoon, S. S. (2017). Topical recombinant human epidermal growth factor for oral mucositis induced by intensive chemotherapy with hematopoietic stem cell transplantation: final analysis of a randomized, double-blind, placebo-controlled, phase 2 trial. PloS one, 12(1), e0168854. doi: 10.1371/journal.pone.0168854

[15] Mahendran, V. J., Stringer, A. M., Semple, S. J., Song, Y., & Garg, S. (2018). Advances in the Use of Anti-inflammatory Agents to Manage Chemotherapy-induced Oral and Gastrointestinal Mucositis. Current pharmaceutical design, 24(14), 1518-1532. doi: 10.2174/1381612824666180409093918

[16] Mori, K., Horinouchi, M., Domitsu, A., Shimotahira, T., Soutome, S., Yamaguchi, T., & Oho, T. (2017). Proper oral hygiene protocols decreased inflammation of gingivitis in a patient during chemotherapy with bevacizumab: a case report. Clinical case reports, 5(8), 1352-1357. doi: 10.1002/ccr3.1034

[17] Order of the Ministry of Health of Ukraine from 30.06.2010 №647. On approval of clinical protocols for the provision of medical care to patients in the specialty “Hematology”. http://moz.gov.ua/ua/portal/dn_20100730_647.html

[18] Paliy, G. K., Nazarchuk, O. A., Faustova, M. O., Pali, V. G., & Yatsula, O. V. (2016). Investigation of the effectiveness of antimicrobials in patients with inflammatory diseases of the oral cavity. Bulletin of problems of biology and medicine, 2(3), 220-225.

[19] Rambod, M., Pasyar, N., & Ramzi, M. (2018). The effect of zinc sulfate on prevention, incidence, and severity of mucositis in leukemia patients undergoing chemotherapy. European Journal of Oncology Nursing, 33, 14-21. doi: 10.1016/j.ejon.2018.01.007

[20] Tallman, M. S., Wang, E. S., Altman, J. K., Appelbaum, F. R., Bhatt, V. R., Bixby, D., ... & Foran, J. M. (2019). Acute Myeloid Leukemia, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, 17(6), 721-749. https://doi.org/10.6004/jnccn.2019.0028

[21] Villa, A., & Sonis, S. T. (2015). Mucositis: pathobiology and management. Current opinion in oncology, 27(3), 159-164. doi: 10.1097/CCO.0000000000000180
Published
2019-06-26
How to Cite
Lysenko, D., Lukianovych, O., Sergyeyev, S., Bobrowska, O., & Gurova, O. (2019). Pharmacological correction of various morphological forms of oral mucositis in patients with leukemia. Reports of Morphology, 25(2), 42-48. https://doi.org/https://doi.org/10.31393/morphology-journal-2019-25(2)-05