The Choice of Multiple Myeloma Induction Therapy Affects the Frequency and Severity of Oral Mucositis After Melphalan-Based Autologous Stem Cell Transplantation

Mucositis is a significant complication of high dose melphalan autologous transplantation (AHSCT) for myeloma. We hypothesized that prior therapy received would impact on mucositis risk in AHSCT. We retrospectively analyzed 128 sequential 200mg/m2 melphalan AHSCT performed as part of primary. There was a significant reduction in mucositis risk in patients receiving immunomodulator based induction therapy compared to conventional chemotherapy. Introduction/Background: Mucositis is a common complication of high-dose melphalan (HDM) used before autologous stem cell transplantation (ASCT) for multiple myeloma (MM). Mucositis rates are influenced by previous chemotherapy (CT) exposure. We examined the effect of induction therapy before ASCT on ASCT mucositis rates. Patients and Methods: Patients undergoing first 200 mg/m(2) HDM ASCT were assessed. Those receiving <200 mg/m(2), or those with previous ASCT were excluded. Patients were evaluated depending on type of induction therapy (CT, immunomodulatory drug [IMID], or proteasome inhibitor [PI]) before ASCT. A case record review was performed and data collected on response to induction, rates of Grade 3/4 mucositis, and days of total parenteral nutrition (TPN) or parenteral opiate analgesia. Results: One hundred twenty-eight patients with ASCT were assessed. Induction therapy was CT- (n = 62), IMiD- (n = 51), or PI-based (n = 15) therapy. Patient characteristics were overall similar, including median age, MM stage, and CD34(+) cell dose. IMiD-based therapy patients had lower rates of mucositis (33% vs. 53%; P = .03) and less opiate requirements (10% vs. 31%; P = .02) compared with those treated with CT. Rates of mucositis and opiate use in the PI group were not different to the CT cohorts (33% vs. 53%; P = .6 and 13% vs. 31%; P = .13), likely due to concurrent anthracycline exposure. TPN usage was similar (CT, 42%; IMiD, 35%; and PI, 20%), as was neutropenia duration and antibiotic usage. Conclusion: Patients treated with IMiD-based regimens before HDM ASCT had significantly lower rates of mucositis than those treated with CT-based therapy. There were too few patients who received PI therapy to evaluate the effect.