Oral Mucositis Measured by the Oral Mucositis Assessment Scale (OMAS), but Not by the World Health Organization (WHO) Scoring System, Correlates with Nutritional Changes after Autologous Peripheral Blood Stem Cell Transplantation.
Authors: Toro Juan J. , Arango Jorge I. , Westbrook Steven D. , Jewell Pamela S. , Shuko Lee , Ochoa-Bayona Jose L. , Freytes Cesar O. 
Published: October 2019

Abstract
Objective: There is limited information regarding the relationship between oral mucositis (OM) and the nutritional status of autologous peripheral stem cell transplantation (APSCT) recipients. The objective of this study was to determine the relationship between OM, measured by two different instruments, and the nutritional status change of patients undergoing APSCT for lymphoid malignancies.
Design: Eighty-two APSCT recipients were prospectively evaluated for OM by a physician or dentist not directly taking care of the patient. Oral examinations were performed 1–2 days before the administration of the conditioning regimen, the day of the transplant and 3 times weekly until resolution of mucositis. The presence of OM was assessed utilizing the objective portion of the OMAS which takes into account the degree of erythema and ulceration; and the WHO scoring system which combines both objective mucosal changes with functional outcomes such as the ability to eat. A registered dietician assessed the nutritional status (NS) of the patients before conditioning and at day 14 after transplantation, utilizing the Nutritional Status Classification Scheme (NSCS). The NSCS is a validated instrument developed by the Department of Veterans Affairs that stratifies patients in 4 categories or levels based on 7 indicators including nutrition history, unintentional weight loss, percent of ideal weight, diet, diagnosis, albumin, and total lymphocyte count. Defined levels range from patients with normal NS (level 1) to patients with severely compromised NS (level 4).
Results: The mean age of study subjects was 56 (19–74) years, of these patients 76 (93%) were males. Of the 82 patients, 60 (73%) had multiple myeloma (MM), 17 (21%) had non-Hodgkin’s lymphoma (NHL), and 5 (6%) had Hodgkin’s lymphoma (HL). Conditioning regimens consisted of melphalan in 60 (73%), the combination of cyclophosphamide, etoposide and BCNU (CBV) in 19 (23%), and 3 (4%) received BCNU, etoposide, cytarabine, and melphalan (BEAM). Only 18% of the patients had a normal NS (level 1) before transplant. Most patients (73%) had mildly compromised NS (level 2) before transplant and the rest (9%) had moderately compromised NS (level 3). There was a statistically significant decrement in the NS 14 days after transplantation: 62% of the patients had moderate NS (level 3) and 5% has severely compromised NS (level 4) (p=0.002).Some degree of OM developed in 74 (90%) patients using the OMAS and 71 (87%) patients using the WHO scoring system. The NS change was associated with the OMAS (p=0.003) score but not with the WHO scoring system (p=0.094). There were no statistically significant correlation between change in NS and type of disease (0.496), conditioning regimen (0.496) and diarrhea (0.8849). There was a statistically significant correlation between change in NS and pain on swallowing (P=0.022), days with fever (P=0.036), neutrophil (P=0.01) and platelet (P=0.045) engraftment and length of hospital stay (P=0.004).
Conclusions: Oral mucositis measured by the OMAS, but not by the WHO scoring system, correlates with nutritional changes after APSCT in patients with lymphoid malignancies. Decrement of the nutritional level in the NSCS correlated with adverse clinical outcome.