Published in Cancer Detection and Prevention 2000; 24(Supplement 1).

Amelioration of the symptoms of mucositis with a calcium phosphate rinse and topical fluoride in BMT patients

AS Papas MD PhD, KT O'Laughlin MD MS, G Martuscelli MD MMSc, E Clark PhD, KB Miller MD

Tufts University School of Dental Medicine and New England Medical Center,

Oral mucositis is a significant complication of cancer therapies. It produces considerable pain and morbidity and can lead to systemic infection due to the entry of oral bacteria, fungi, and viruses through ulcerated mucosa. Approximately 25% of septic events in neutropenic patients are of oral origin. Methods to prevent mucositis are limited. AIMS: This study reports on a double blind prospective randomized clinical trial of a calcium phosphate mouth rinse (Caphosol)and fluoride tray treatment versus a standard regimen of fluoride rinsing and placebo tray treatment. METHODS: Sixty-one patients undergoing BMT(32 autologous/ 29 allogeneic) were pre-treated with necessary dental treatment, a cleaning, and oral hygiene instructions. Patients were randomized into one of the two regimens and examined for mucositis and oral infection at least three times a week during neutropenia by the study dentist blinded to the treatment. Patients were asked to rate their intraoral pain through a visual analogue scale (VAS). Objective measurement of morphine sulfate (MSO4) use for relief of intraoral pain was also compared between the two groups. RESULTS: Statistically significant decreases in peak mucositis pain (VAS= 23vs.39) and mg. of adjunctive MSO4 (5.8 vs. 12.5) used were observed in the Caphosol vs.Fluoride rinse group (Mann -Whitney test p= 0.04). For allogeneic patients a significantly reduction in the number of days to ANC 200 engraftment (12.7 vs. 16.5) was observed in the Caphosol vs.the Fluoride rinse group (Student t test p= 0.02) CONCLUSION: Caphosol may be a useful adjunct to the management of oral mucositis in BMT patients.

KEY WORDS: Calcium phosphate rinse, mucositis, fluoride rinse, oral pain.

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Paper presented at the International Symposium on Impact of Biotechnology on Cancer Diagnostic & Prognostic Indicators; Geneva, Switzerland; October 28 - 31, 2000; in the section on novel therapies.