Comparing the risk of severe oral mucositis associated with methotrexate as graft-versus host-disease prophylaxis to other immunosuppressive prophylactic agents in hematopoietic cell transplantation: a systematic review and meta-analysis.

التفاصيل البيبلوغرافية
العنوان:	Comparing the risk of severe oral mucositis associated with methotrexate as graft-versus host-disease prophylaxis to other immunosuppressive prophylactic agents in hematopoietic cell transplantation: a systematic review and meta-analysis.
المؤلفون:	Al-Jamaei AAH; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, The Netherlands.; Department of Oral Medicine, Periodontics, Diagnostic, and Oral Radiology, Faculty of Dentistry, Sanaá University, Sanaá, Yemen.; Department of Oral Surgery and Oral Medicine, Al-Razi University, Sanaá, Yemen., Epstein JB; Cedars-Sinai Medical Center, Los Angeles, CA, USA.; City of Hope Comprehensive Cancer Center, Duarte, CA, USA., de Visscher JGAM; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, The Netherlands., Spielberger RT; Department of BMT, Southern California Permanente Medical Group, Kaiser Permanente, Los Angeles, CA, USA.; Department of Hematology &, Center for Stem Cell Transplantation at City of Hope Comprehensive Cancer Center, Hematopoietic Cell Transplantation, Duarte, CA, USA., Nakamura R; Department of Hematology &, Center for Stem Cell Transplantation at City of Hope Comprehensive Cancer Center, Hematopoietic Cell Transplantation, Duarte, CA, USA., Raber-Durlacher JE; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Amsterdam, The Netherlands. j.raber.durlacher@acta.nl.; Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands. j.raber.durlacher@acta.nl.
المصدر:	Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer [Support Care Cancer] 2024 Jul 17; Vol. 32 (8), pp. 519. Date of Electronic Publication: 2024 Jul 17.
نوع المنشور:	Journal Article; Systematic Review; Meta-Analysis; Comparative Study; Review
اللغة:	English
بيانات الدورية:	Publisher: Springer International Country of Publication: Germany NLM ID: 9302957 Publication Model: Electronic Cited Medium: Internet ISSN: 1433-7339 (Electronic) Linking ISSN: 09414355 NLM ISO Abbreviation: Support Care Cancer Subsets: MEDLINE
أسماء مطبوعة:	Original Publication: Berlin : Springer International, c1993-
مواضيع طبية MeSH:	Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/methods , Graft vs Host Disease/prevention & control , Graft vs Host Disease/etiology , Stomatitis/etiology , Stomatitis/prevention & control , Methotrexate/administration & dosage , Methotrexate/therapeutic use , Methotrexate/adverse effects , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents*/adverse effects, Humans ; Randomized Controlled Trials as Topic ; Severity of Illness Index
مستخلص:	Purpose: This study examines the risk of severe oral mucositis (SOM) in graft-versus-host disease prophylaxis (GVHD) compared to other agents in hematopoietic cell transplantation patients. Methods: A comprehensive search of four databases, including PubMed, Embassy, Web of Science, and Scopus, was conducted to identify studies reporting frequency and severity of oral mucositis in association with GVHD prophylactic regimens. RevMan 5.4 was used to perform the meta-analysis. Risk of bias assessment was carried out using the Rob-2 tool for randomized clinical trials (RCTs) and ROBINS-I tool for observational studies. Results: Twenty-five papers, including 11 RCTs and 14 observational studies, met the inclusion criteria. The pooled results from eight RCTs showed a higher risk of SOM in patients receiving MTX or MTX-inclusive GVHD prophylaxis versus non-MTX alternatives (RR = 1.50, 95% CI [1.20, 1.87], I ² = 36%, P = 0.0003). Mycophenolate mofetil (MMF) and post-transplant cyclophosphamide (Pt-Cy) consistently showed lower risk of mucositis than MTX. Folinic acid (FA) rescue and mini-dosing of MTX were associated with reduced oral mucositis severity. Conclusion: Patients receiving MTX have a higher SOM risk compared to other approaches to prevent GVHD, which should be considered in patient care. When appropriate, MMF, FA, and a mini-dose of MTX may be an alternative that is associated with less SOM. This work also underlines the scarcity of RCTs on MTX interventions to provide the best evidence-based recommendations. (© 2024. The Author(s).)
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فهرسة مساهمة:	Keywords: Graft versus host disease; HCT; Hematopoietic cell transplantation; Methotrexate; Oral mucositis
المشرفين على المادة:	YL5FZ2Y5U1 (Methotrexate) 0 (Immunosuppressive Agents)
تواريخ الأحداث:	Date Created: 20240717 Date Completed: 20240717 Latest Revision: 20240717
رمز التحديث:	20240717
DOI:	10.1007/s00520-024-08722-w
PMID:	39017899
قاعدة البيانات:	MEDLINE

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