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.

(2019). PD-1/PD-L1 expression in extramedullary lesions of acute myeloid leukemia. Leukemia & Lymphoma. Ahead of Print.

Objectives: Mucositis is a debilitating side effect of cancer therapy that adversely affects quality of life, cost of care, and the outcome of cancer therapy. Oral mucositis-related pain may be treated with numerous modalities but often includes opioids. The effects of opiate treatment on painful UM and its overall influence on the burden of illness (BOI) in cancer patients remain unknown. Methods: This study utilized the 2017 United States (US) National Inpatient Sample (NIS) database. The exposure was opioid treatment for chemo-induced ulcerative mucositis (UM), oral mucositis-induced pain, and the main outcomes included in-hospital mortality and BOI, length of hospital stays (LOS), and total hospital charges. Multivariable regression analysis was used to examine the relationship between outcomes and the key independent variable, opioid use, adjusting for propensity scores. Results: In the propensity score-adjusted analysis, UM patients with opioid treatment had 0.51 times lower total charges (95% CI: 0.42–0.76) and 0.67 times shorter LOS (95% CI: 0.51–0.87) than the UM patients without opioid treatment. However, there was no association between opioid treatment and in-hospital mortality. In the sensitivity analysis, the effect estimates were comparable in the propensity score-adjusted analysis, the decile-adjusted model, and the full model with the non-propensity score estimated method. Conclusions: Cancer patients with chemotherapy-induced UM-prescribed opioid analgesics for treating pain are associated with a lower BOI. Opioid pain medications are commonly provided to cancer survivors; estimating the BOI among them is crucial in supportive care research.

Adult acute lymphoblastic leukemia (ALL) management has traditionally relied upon pre‐treatment conventional risk factors for treatment decisions. Despite using intensive multiagent chemotherapy followed by a prolonged maintenance or allogeneic stem cell transplantation, these patients remain at a high risk of relapse. Improved techniques for detection of measurable residual disease (MRD) have tremendously changed the posttreatment disease burden assessment and evolved as a powerful predictor of relapse and survival superseding historical prognostic factors. More‐over, MRD measurement has become an integral part of risk stratification, prognosis assessment, intensification or de‐escalation of treatment, monitoring of disease burden and an endpoint in clinical trials. With existing approaches like allogeneic hematopoietic stem cell transplantation (HSCT) and emergence of novel agents (eg, blinatumomab, inotuzumab ozogamicin, and chimeric antigen receptor [CAR] T cells) that are highly effective in eradicating residual disease, understanding the role of MRD in treatment decisions is getting more and more important and complex. This review will highlight the advances that have been achieved in MRD monitoring over the years and the practical applications in different time points of treatment to provide a framework for rational management decisions by practicing hematologists and oncologists.

Background. Oral mucositis is a major toxicity of hematopoietic stem-cell transplantation (HSCT). Glucagon-like peptide-1 (GLP-1) signaling promotes epithelial repair and attenuates inflammation after high-dose chemotherapy, but its relationship to oral mucositis after transplantation is undefined. We hypothesized that semaglutide would be associated with a lower risk of stomatitis and oral mucositis, without increased xerostomia, and with fewer systemic complications. Methods. Using the TriNetX federated network, adults aged 18–90 with stem-cell transplant status (ICD-10-CM Z94.84) were classified as semaglutide-exposed or unexposed. Outcomes were assessed from day 30 after the index event, with a prespecified 90-day analysis for oral mucositis. Primary endpoints were stomatitis (K12) and ulcerative oral mucositis (K12.3). Secondary endpoints included dry mouth, dysgeusia, systemic inflammation, and mortality. One—to—one propensity matching was used to balance age, sex, race/ethnicity, diabetes, and comorbidities. Results. After matching 1,355 pairs, stomatitis occurred in 4.0% versus 10.6% (risk ratio [RR] 0.378, 95% CI 0.262–0.545; hazard ratio [HR] 0.476, 95% CI 0.323-0.700; P<0.001). At 90 days, oral mucositis occurred in 2.43% versus 8.39% (RR 0.29, 95% CI 0.189-0.446; HR 0.278, 95% CI 0.179–0.431; P<0.0001). Dry mouth and taste/smell disturbances did not differ. Exposed patients had lower risks of sepsis-spectrum inflammation (6.2% versus 13.1%), influenza/pneumonia (11.6% versus 23.8%), and death (6.7% versus 25.0%). Conclusions. Semaglutide exposure was associated with lower coded oral mucositis, without increased xerostomia, and with concordant reductions in infectious and mortality outcomes. These findings warrant prospective confirmation and do not establish a preventive indication.