Myeloma Clinical Trial
Official title:
Cryotherapy as Prophylaxis Against Oral Mucositis After High-dose Melphalan and Autologous Stem Cell Transplantation for Myeloma: a Randomised, Open-label, Phase 3, Non-inferiority Trial Comparing Two and Seven Hours of Cryotherapy.
In this prospective, randomised, controlled, open-label, Phase III, non-inferiority clinical trial trial patients with a diagnosis of myeloma who were undergoing autologous HSCT were randomised 1:1 to receive cryotherapy for 7 hours or 2 hours . Oral mucositis was evaluated prospectively.
We searched MEDLINE and PubMed with the following phrases: "oral mucositis", "oral toxicity",
"cryotherapy", "myeloma", "autologous haematopoietic stem cell transplantation", "randomised
trial" and "high-dose melphalan".
Oral mucositis, which is a side effect of high-dose chemotherapy, has a major negative impact
on the quality of life and survival of patients who undergoing autologous haematopoietic stem
cell transplantation (auto-HSCT). For patients with myeloma cryotherapy gives a significant
reduction in oral mucositis. The mechanism of action is suggested to be vasoconstriction that
is induced by the cooling of the oral mucosa, thereby protecting it from the cytotoxic
effects of the chemotherapy. The therapeutic efficacy of cryotherapy in this setting has been
confirmed in several trials, it is currently regarded as the standard of care prophylactic
regimen for oral mucositis in patients undergoing auto-HSCT for myeloma. However, the long
duration of the treatment (7 hours), as reported in the original, placebo-controlled study in
2006, has been associated with significant discomfort for the patients, with negative
consequences for compliance.
Uncontrolled trials have previously tested cryotherapy for less than 7 hours in patients with
myeloma who receive auto-HSCT. At the time of the planning of the current study in 2014,
those results were not yet confirmed in any randomised trial. However last year a randomised
trial was published, showing that 2-hour cryotherapy is equally as effective as 6-hour
cryotherapy in preventing oral mucositis in patients with myeloma who are treated with
high-dose melphalan. The present prospective, randomised study aimed to investigate whether 2
hours of cryotherapy is as effective as 7 hours of cryotherapy in protecting against oral
mucositis those patients who are subjected to high-dose melphalan as a conditioning agent for
auto-SCT for myeloma.
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