Study On The Risk Factors And Clinical Impacts Of Oral Mucositis In Unrelated Cord Blood Transplant Recipients

ObjectivesAllogeneic hematopoietic stem cell transplantation(allo-HSCT)has been a pivotal method to treat hematological malignancies,hematopoietic failure diseases and inherited metabolic diseases.Unrelated cord blood is one of the important sources of hematopoietic stem cells.Oral mucositis(OM)is a common symptom in allo-HSCT patients.However,the data of OM in unrelated cord blood transplantation(UCBT)recipients is limited.The aim of this study was to evaluate the incidence,risk factors and clinical impacts of OM in UCBT recipients.MethodsThe clinical data of 640 patients who received UCBT at the First Affiliated Hospital of the University of Science and Technology of China(Anhui Provincial Hospital)during the period January 2016 to December 2019 was retrospectively analyzed.OM was evaluated according to a semiquantitative scoring system.The patients were divided into OM group and non-OM group according to whether OM occurred during UCBT.Univariate analysis was carried out firstly.Variables with statistical differences in univariate analysis were included in a binary logistic regression multivariate analysis to explore independent risk factors for OM in UCBT patients.Comparison of OM group and non-OM group,as well as OM grade 0 group,OM grade1-2 group and OM grade 3-4 group was conducted to determine clinical impacts of OM on indicators including hospitalization days,hospitalization expenses,the incidence of early BSI,the incidence of acute gastrointestinal graft-versus-host disease(GVHD)and100-day mortality.ResultsOM occurred in 435 patients(67.97%)of included patients(37.03% grade 1,23.28% grade 2,5.78% grade 3,1.88% grade 4),began at day +5(+3,+7)after cord blood infusion,lasted for 7(4,10)days and resolved on day +12(+10,+14).Univariate analysis of OM risk factors in UCBT patients showed that age(P<0.001),disease diagnosis(P<0.001),disease status(P=0.007),composition of conditioning regimen(P=0.002),intensity of conditioning regimen(P<0.001),human leukocyte antigen(HLA)matching(P=0.008)and total number of nuclear cells(TNC)of cord blood(P<0.001)were statistically significant between OM group and non-OM group.Multivariate analysis showed that age ≥18 years(OR=3.052,95% CI 1.966-4.736,P<0.001),diagnosis of malignant hematopathy(OR=2.352,95% CI 1.038-5.331,P=0.040)and myeloablative conditioning regimen(OR=3.253,95% CI 1.359-7.790,P=0.008)were independent risk factors of OM in UCBT recipients.The incidence of early BSI(P=0.041)and the incidence of II-IV acute gastrointestinal GVHD(P< 0.001)were higher in the OM group than in the non-OM group,accompanying more hospitalization expenses(P<0.001).Differences between OM grade 0 group and OM grade 1-2 group in hospitalization expenses(P<0.001)and the incidence of II-IV acute gastrointestinal GVHD(P<0.001)were statistically significant.Except for hospitalization days(P=0.033),there was a statistical difference in all clinical impact indicators(P≤0.017)between OM grade 1-2 group and OM grade 3-4 group.Differences between OM grade 0 group and OM grade 3-4 group in all clinical impact indicators were statistically significant(P≤0.017).ConclusionsThe total incidence of OM in UCBT patients is high,but the incidence of severe OM is low.UCBT patients with OM have higher incidence of II-IV acute gastrointestinal GVHD and more hospitalization costs.And patients with severe OM experience longer hospitalization days,higher incidence of early BSI and higher100-day mortality.OM is worthy of attention in UCBT patients.This study found that age ≥18 years,diagnosis of malignant hematopathy and myeloablative conditioning regimen are independent risk factors of OM in UCBT recipients,facilitating clinical nursing staff to identify high-risk populations and implement early interventions to reduce the incidence and severity of OM and improve clinical outcomes of UCBT recipients.