Mucositis : Early complications of allogeneic transplant

Mucositis, associated with HSCT, is characterised by widespread ulceration of

the moveable, non-keratinised mucosae of the oral cavity most commonly
involving the buccal mucosa and the ventrolateral tongue (Scully, Sonis et al.
2006). Oesophageal and gastrointestinal systems are also affected. It is a
common acute toxicity associated with both intense chemotherapy reserved for
haematological malignancies as well as head and neck radiation, both being
integral components of HSCT. Oropharyngeal mucositis may result in severe
discomfort and is the most common symptom and distressing complication of
HSCT (Bellm, Epstein et al. 2000). Furthermore, concurrent herapy related
immunosuppression, specifically neutropoenia, places patients at risk of
bacteraemia, septicemia and fungaemia (Ruescher, Sodeifi et al. 1998).
Clinically, mucositis first presents as generalized erythema approximately 4-5
days following the initiation of chemotherapy or following a cumulative
radiation dose of 10Gy to the head and neck region. At 7-10 days following
chemotherapy frank ulceration occurs, associated with significant pain and
impaired function. Mucositis commonly extends to involve the esophageal and
gastrointestinal mucosa. Opioid analgesics are often essential at this stage and
total parenteral nutrition may be required.