Mucositis involving the gastrointestinal, vaginal, and nasal mucosa is one of the primary dose-limiting toxicities of hematopoietic stem cell transplantation (HSCT) and its conditioning regimen. The oropharyngeal mucosa is commonly affected, which can be detrimental to patient health and quality of life. Despite its significant prevalence and deleterious effects, we have an inadequate understanding of the risk factors and outcomes associated with oral mucositis (OM). We performed a literature search through PubMed and EBSCO (inception to 31 March 2024) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data was extracted from eligible studies using a pre-specified data extraction form. Quality of the data was assessed using the Newcastle-Ottawa Scale for non-randomized, observational studies and the Cochrane Collaboration Tool for randomized controlled trials. Our initial search identified 1677 articles, 34 of which were included in our study. Of those 34, 30 were included in the qualitative assessment of clinical risk factors in the development of OM, and 4 were included in the meta-analysis assessing the relationship between OM and infectious complications following HSCT. Across both HSCT modalities and cancer cohorts, female sex and high-intensity conditioning were common risk factors in the development of OM. When stratified by allogeneic and autologous HSCT, methotrexate, younger age, and longer duration of neutropenia were associated with increased OM risk in allogeneic HSCT recipients, while renal dysfunction, HSV-1 reactivation, and longer neutrophil engraftment were associated with increased OM risk in autologous HSCT recipients. Longer neutrophil engraftment was a common risk factor across different cancer cohorts; however, renal dysfunction was a distinct risk factor for OM in multiple myeloma patients. Additionally, our meta-analysis revealed that patients with OM have an increased risk of developing infectious complications following HSCT compared to those without OM, with an odds ratio of 3.84 (95% CI: 2.51–5.86). The development of OM is related to various risk factors, and individuals with OM are at greater risk of infectious complications. Knowledge of these risk factors and outcomes will help clinicians identify high-risk individuals, prevent OM, and protect an immunocompromised population from subsequent life-threatening complications.

Background: Oral ulcerative mucositis (OUM) is a frequent and severe complication of hematopoietic cell transplantation (HCT). Whether prolonged hospital discharge timing, used as a proxy for extended length of stay (LOS), identifies greater systemic morbidity among patients who develop OUM remains unclear. This retrospective cohort study aimed to evaluate, among HCT recipients with documented OUM, whether prolonged discharge timing is independently associated with increased systemic complications. Methods: This retrospective cohort study utilized the National Inpatient Sample to identify adult patients with leukemia or multiple myeloma undergoing autologous or allogeneic HCT complicated by OUM. Patients were stratified by discharge timing: autologous HCT, 10–19 (control) vs. 20–29 days; allogeneic HCT, 15–24 (control) vs. 25–34 days. Further, no control group of patients undergoing HCT without OUM was examined. Baseline characteristics and systemic outcomes—including healthcare-associated complications incorporating septicemias, isolated septicemia, coagulopathies, hypertension, and congestive heart failure—were compared. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (aOR) for outcomes in prolonged versus shorter discharge strata, adjusting for demographics and comorbidity burden. Results: Among autologous HCT recipients with OUM (weighted n = 1290), 21.7% experienced prolonged discharge. This stratum had significantly higher adjusted rates of healthcare-associated complications, including septicemias (aOR 3.09, 95% CI: 1.45–6.59), isolated septicemia (aOR 4.68, 95% CI: 1.83–11.96), and congestive heart failure (aOR 1.68, 95% CI: 2.44–11.58). Among allogeneic HCT recipients (weighted n = 885), 54.2% had prolonged discharge, associated with increased healthcare-associated complications including septicemias (aOR 3.3, 95% CI: 1.19–9.12), coagulopathies (aOR 3.47 with 95% CI: 1.33–9.03), and hypertension (aOR 2.00 with 95%CI: 1.05–3.82). No adverse outcomes occurred in discharges within 0–10 days. Conclusions: Prolonged discharge timing in HCT patients with OUM is independently associated with substantial systemic morbidity, including septicemia-related complications. Discharge-based stratification highlights high-risk periods amenable to targeted supportive interventions to mitigate complications and facilitate earlier safe discharge.

Background: Cancer treatment-induced ulcerative mucositis (UM) is a debilitating toxicity in patients with cancers of the lip, oral cavity, and pharynx (CLOP). This study evaluated the association of chemotherapy-induced (CT-UM) and radiotherapy-induced ulcerative mucositis (RT-UM) with burden of illness (BOI), focusing on hospital length of stay (LOS) and total charges, and examined disparities in outcomes. Methods: This retrospective cohort study analyzed 2019 National Inpatient Sample (NIS) data. Adult patients (≥18 years) hospitalized with CLOP (ICD-10-CM C00–C14) undergoing inpatient surgery, chemotherapy, or radiotherapy were included. CT-UM (K12.31) and RT-UM (K12.33) were identified as secondary diagnoses. Survey-weighted generalized linear models (negative binomial for LOS; gamma for charges) adjusted for demographics, comorbidities (Elixhauser score), insurance, income, and Diagnosis-Related Groups (DRG; surgical vs. medical) were used. Results: Among 59,710 weighted CLOP hospitalizations, 820 had CT-UM and 1010 had RT-UM. Patients with UM were younger and had varying comorbidity burdens. Unadjusted analyses showed prolonged geometric mean LOS for CT-UM (5.66 vs. 3.81 days, p < 0.001) and RT-UM (4.95 vs. 3.81 days, p = 0.001), with lower total charges ($48,645 and $42,938 vs. $56,267). Multivariable analyses confirmed RT-UM was associated with increased LOS (adjusted coefficient 1.33, 95% CI 1.14–1.55) but lower charges (0.67, 95% CI 0.56–0.81). In patients >50 years, CT-UM showed stronger effects (LOS 1.80, 95% CI 1.49–2.15; charges 0.79, 95% CI 0.65–0.98). Significant disparities were observed: females, Black and Hispanic patients, and Medicaid beneficiaries experienced greater BOI (prolonged LOS and/or higher charges in subgroups). Associations persisted in DRG- and procedure-stratified sensitivity analyses, suggesting treatment interruptions as a key driver. Conclusions: Ulcerative mucositis in hospitalized CLOP patients is associated with prolonged LOS but lower charges, likely due to treatment modifications, and disproportionately affects vulnerable populations. These findings highlight the need for proactive oral care protocols, multidisciplinary integration, and equity-focused interventions to reduce the burden of this toxicity and improve cancer treatment outcomes.