International Journal of Hematology-Oncology and Stem Cell Research 2018. 12(2):142-152.

Factors Affecting the Incidence and Severity of Oral Mucositis Following Hematopoietic Stem Cell Transplantation
Maryam Valeh, Mona Kargar, Ava Mansouri, Hosein Kamranzadeh, Kheirollah Gholami, Kazem Heidari, Moluk Hajibabaei


Background: Patients who receive hematopoietic stem cell transplantation (HSCT) experience several complications that oral mucositis (OM) is a frequent symptom. This study was designed to evaluate the incidence, risk factors, prophylaxis and treatment strategies for established OM.

Materials and Methods: We included 173 adult patients who received autologous or allogeneic hematopoietic stem cell transplantation in this study. The World Health Organization oral toxicity scale was used to assess the severity of OM. Patients received two prophylactic regimens: regimen 1 contained nystatin, chlorhexidine, povidone iodine and amphotericin B. Regimen 2 contained nystatin and povidone iodine. 70 patients (40.5%) received the first prophylaxis regimen, 89 patients (51.4%) received the second prophylaxis regimen and the remaining 14 patients (8.1%) were not adherence to the use of the mouthwashes and were excluded from the analysis.

Results: OM was detected in 60.7% of patients with mean (SD) age of 38.1±14.6 years. Multivariate analysis showed that only the female gender and the prophylactic regimen were the significant predictors of OM.

Conclusion: We found that addition of amphotericin B and chlorhexidine, to the nystatin and povidone iodine resulted in a significant beneficial effect in prevention OM.





Oral Mucositis (OM), Nystatin, Povidone iodine, Amphotericin, Chlorhexidin

Full Text:



Gratwohl A, Baldomero H, Aljurf M, et al. Hematopoietic stem cell transplantation: a global perspective. JAMA. 2010; 303(16):1617-24.

Moslehi A, Taghizadeh-Ghehi M, Gholami K, et al. N-acetyl cysteine for prevention of oral mucositis in hematopoietic SCT: a double-blind, randomized, placebo-controlled trial. Bone Marrow Transplant. 2014;49(6):818-23.

Lee J-H, Lim G-Y, Im SA, et al. Gastrointestinal complications following hematopoietic stem cell transplantation in children. Korean J Radiol. 2008; 9(5):449-457.

Kamińska M, Juszkiewicz M, Tymicka R, et al. Procedure in the prevention and nurturing of inflammatory changes of oral mucositis among patients treated for oncological conditions. Medical Studies/Studia Medyczne. 2016;32(2):145-149.

Epstein JB, Thariat J, Bensadoun RJ, et al. Oral complications of cancer and cancer therapy. CA Cancer J Clin. 2012;62(6):400-22.

Raber-Durlacher JE, Elad S, Barasch A. Oral mucositis. Oral Oncol. 2010;46(6):452-6.

Peterson DE, Boers-Doets CB, Bensadoun RJ, et al. Management of oral and gastrointestinal mucosal injury: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol. 2015;26 suppl 5:v139-51.

Vagliano L, Feraut C, Gobetto G, et al. Incidence and severity of oral mucositis in patients undergoing haematopoietic SCT—results of a multicentre study. Bone Marrow Transplant. 2011;46(5):727-32.

Pico JL, Avila-Garavito A, Naccache P. Mucositis: its occurrence, consequences, and treatment in the oncology setting. Oncologist. 1998;3(6):446-451.

Tuncer HH, Rana N, Milani C, et al. Gastrointestinal and hepatic complications of hematopoietic stem cell transplantation. World J Gastroenterol. 2012;18(16):1851-1860.

Jahangard-Rafsanjani Z, Gholami K, Hadjibabaie M, et al. The efficacy of selenium in prevention of oral mucositis in patients undergoing hematopoietic SCT: a randomized clinical trial. Bone Marrow Transplant. 2013;48(6):832-6.

Worthington HV, Clarkson JE, Bryan G, et al. Interventions for preventing oral mucositis for patients with cancer receiving treatment. The Cochrane Database Syst Rev. 2011;(4):CD000978.

Lalla RV, Sonis ST, Peterson DE. Management of oral mucositis in patients with cancer. Dent Clin North Am. 2008;52(1):61-viii.

Sorensen JB, Skovsgaard T, Bork E, et al. Double‐blind, placebo‐controlled, randomized study of chlorhexidine prophylaxis for 5‐fluorouracil‐based chemotherapy‐induced oral mucositis with nonblinded randomized comparison to oral cooling (cryotherapy) in gastrointestinal malignancies. Cancer. 2008;112(7):1600-6.

Cerchietti LC, Navigante AH, Bonomi MR, et al. Effect of topical morphine for mucositis‐associated pain following concomitant chemoradiotherapy for head and neck carcinoma. Cancer. 2002;95(10):2230-6.

Sonis ST. Oral mucositis. Anticancer Drugs. 2011;22(7):607-12.

Hosseinjani H, Hadjibabaie M, Gholami K, et al. The efficacy of erythropoietin mouthwash in prevention of oral mucositis in patients undergoing autologous hematopoietic SCT: a double‐blind, randomized, placebo‐controlled trial. Hematol Oncol. 2017;35(1):106-112.

Jensen SB, Jarvis V, Zadik Y, et al. Systematic review of miscellaneous agents for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21(11):3223-32.

Niscola P, Romani C, Scaramucci L, et al. Pain syndromes in the setting of haematopoietic stem cell transplantation for haematological malignancies. Bone Marrow Transplant. 2008;41(9):757-64.

Organization WH. WHO handbook for reporting results of cancer treatment. 1979.

Wardley AM, Jayson GC, Swindell R, et al. Prospective evaluation of oral mucositis in patients receiving myeloablative conditioning regimens and haemopoietic progenitor rescue. Br J Haematol. 2000;110(2):292-9.

Blijlevens N, Schwenkglenks M, Bacon P, et al. Prospective oral mucositis audit: oral mucositis in patients receiving high-dose melphalan or BEAM conditioning chemotherapy—European Blood and Marrow Transplantation Mucositis Advisory Group. J Clin Oncol. 2008;26(9):1519-25.

Rapoport AP, Miller Watelet LF, Linder T, et al. Analysis of factors that correlate with mucositis in recipients of autologous and allogeneic stem-cell transplants. J Clin Oncol. 1999;17(8):2446-53.

Vokurka S, Bystrická E, Koza V, et al. Higher incidence of chemotherapy induced oral mucositis in females: a supplement of multivariate analysis to a randomized multicentre study. Support Care Cancer. 2006;14(9):974-6.

Vokurka S, Steinerova K, Karas M, et al. Characteristics and risk factors of oral mucositis after allogeneic stem cell transplantation with FLU/MEL conditioning regimen in context with BU/CY2. Bone Marrow Transplant. 2009;44(9):601-5.

Salvador PT. Factors influencing the incidence and severity of oral mucositis in patients undergoing autologous stem cell transplantation. Can Oncol Nurs J. 2005;15(1):29-34.

Lalla RV, Bowen J, Barasch A, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014;120(10):1453-61.

Potting C, Uitterhoeve R, REIMER O, et al. The effectiveness of commonly used mouthwashes for the prevention of chemotherapy‐induced oral mucositis: a systematic review. Eur J Cancer Care (Engl). 2006;15(5):431-9.

Bolwell B, Kalaycio M, Sobecks R, et al. A multivariable analysis of factors influencing mucositis after autologous progenitor cell transplantation. Bone Marrow Transplant. 2002;30(9):587-91.

Alvariño-Martín C, Sarrión-Pérez MG. Prevention and treatment of oral mucositis in patients receiving chemotherapy. J Clin Exp Dent. 2014; 6(1): e74–e80.

Vokurka S, Bystřická E, Koza V, et al. The comparative effects of povidone-iodine and normal saline mouthwashes on oral mucositis in patients after high-dose chemotherapy and APBSCT—results of a randomized multicentre study. Support Care Cancer. 2005;13(7):554-8.

Epstein JB, Truelove EL, Hanson-Huggins K, et al. Topical polyene antifungals in hematopoietic cell transplant patients: tolerability and efficacy. Support Care Cancer. 2004;12(7):517-25.

Chan A, Ignoffo RJ. Survey of topical oral solutions for the treatment of chemo-induced oral mucositis. J Oncol Pharm Pract. 2005;11(4):139-43.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.