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Role of antioxidants in buccal mucosa cells and plasma on the incidence and severity of oral mucositis after allogeneic haematopoietic cell transplantation

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Abstract

Purpose

Oral mucositis (OM) is known to be a significant complication of chemotherapy preceding haematopoietic cell transplantation (HCT). Antioxidants (AOX) scavenge free radicals, which play a major role in the initiation of OM and may reduce the OM risk.

Study design

The primary objective of this prospective study was to investigate the association between the incidence and severity of OM (WHO oral toxicity scale) and the AOX status in buccal mucosa cells (BMC) and plasma. The α-tocopherol, ascorbic acid and ß-carotene concentrations in BMC and plasma were assessed at admission in 70 patients with a median age of 58 years before undergoing allogeneic HCT.

Results

Severe OM (III–IV), ulcerative OM (II–IV) and no or mild OM (0–I) were documented in 14 (20.0%), 32 (45.7%) and 38 (54.3%) patients, respectively. We observed no significant differences in baseline AOX concentrations in plasma or BMC among the OM groups. However, between patients with at least one plasma AOX beneath the normal range (39/70) and those with all plasma AOX in the normal range (31/70), we noted a trend towards longer duration of parenteral nutrition (PN) during the study period (10 vs. 8 days; p = 0.066).

Conclusions

No single AOX, either in plasma or BMC (α-tocopherol, ascorbic acid and ß-carotene), revealed predictive value for the incidence or severity of OM. However, patients with an overall good plasma AOX status tended to require less PN, a common clinical marker for OM, which may be more relevant than any one AOX at reducing the risk of OM.

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Acknowledgments

We are grateful to Carole Cürten for proofreading this manuscript, to Gabriele Ihorst from the Institute of Medical Biometry of the Albert-Ludwigs University of Freiburg for the statistical advice and to Monika Neher for data collection. The authors' responsibilities were as follows: PU: study concept and design, obtaining funding, statistical analysis, data collection and interpretation and writing the manuscript; AR: statistical analysis, data collection and interpretation and writing the manuscript; HB: supervision of the study, critical review and contribution to the final draft; and HKB: study concept, critical review and contribution to the final draft. All authors have read and approved the final manuscript. None of the authors expresses a conflict of interest. PU was supported by the National Research Fund, Luxemburg, and young scientist award for financial support for material and analytics issued in 2008 by the German Society for Clinical Nutrition (DGEM e.V.).

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Authors and Affiliations

  1. Department of Haematology/Oncology, Section of Nutrition, Albert Ludwigs-University Medical Center Freiburg, Hugstetter Str 55, 79106, Freiburg, Germany

    Paul Urbain & Anna Raynor

  2. Department of Haematology/Oncology, Section of Allogeneic Stem Cell Transplantation, Albert Ludwigs-University Medical Center Freiburg, Freiburg, Germany

    Hartmut Bertz

  3. Department of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany

    Paul Urbain, Anna Raynor, Christine Lambert & Hans-Konrad Biesalski

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  1. Paul Urbain
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Correspondence to Paul Urbain.

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Urbain, P., Raynor, A., Bertz, H. et al. Role of antioxidants in buccal mucosa cells and plasma on the incidence and severity of oral mucositis after allogeneic haematopoietic cell transplantation. Support Care Cancer 20, 1831–1838 (2012). https://doi.org/10.1007/s00520-011-1284-8

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