melphalan and Enteritis

Lower alimentary tract mucositis is a serious complication of chemotherapy. The aim of the study was to determine the incidence, risk factors, and mortality of lower alimentary tract mucositis in a homogeneous population of patients with newly diagnosed myeloma receiving similar antineoplastic therapy and standardized supportive care.. Lower alimentary tract mucositis was evaluated among 303 consecutive patients with myeloma (2004-2007) enrolled in a clinical trial consisting of induction chemotherapy, tandem melphalan-based autologous stem cell transplantation (ASCT), and consolidation. Lower alimentary tract mucositis was defined as neutropenia-associated grade II-IV enteritis/colitis. Pretreatment risk factors were examined including body surface area (BSA), serum albumin (albumin), and estimated creatinine clearance (CrCl). Multiple logistic regression model was used to compute adjusted odds ratio (OR) and 95% confidence intervals (CI).. Forty-seven (15.5%) patients developed lower alimentary tract mucositis during 1529 courses of chemotherapy (including 536 melphalan-based ASCT). Pre-enrollment BSA <2 m² (OR, 2.768; 95% CI, 1.200-6.381; P = .0169) increased the risk for lower alimentary tract mucositis, whereas higher albumin was protective (OR, 0.698; 95% CI, 0.519-0.940; P = .0177). Pretransplant variables associated with lower alimentary tract mucositis were BSA <2 m² (OR, 4.451; 95% CI, 1.459-13.58, P = .0087) and estimated CrCl <60 mL/min (OR, 3.493; 95% CI, 1.173-10.40; P = .0246). Higher albumin level conferred protection (OR, 0.500; 95% CI, 0.304-0.820; P = .0061). No lower alimentary tract mucositis-related death was observed.. Lower alimentary tract mucositis is not uncommon among a homogenous population of oncology patients undergoing sequential courses of chemotherapy including melphalan-based ASCT but does not contribute to mortality. Lower BSA, renal function, and albumin are associated with increased risk for lower alimentary tract mucositis.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Body Surface Area; Colitis; Enteritis; Female; Hematopoietic Stem Cell Transplantation; Humans; Incidence; Kidney; Male; Melphalan; Middle Aged; Mucositis; Multiple Myeloma; Risk Factors

Thirty-one patients with histologically confirmed FIGO Stage II adenocarcinoma of the ovary were prospectively treated in two sequential studies: 3000 rad of whole abdominal radiation therapy over 6 weeks by an open field technique followed by 2000 rad pelvic boost over 2 weeks (group 1, 16 patients, 1972-1974) or 5000 rad of pelvic radiation therapy over 5 weeks followed by a year of melphalan chemotherapy at a dose of 0.2 mg/kg/day for 5 days every 4 weeks (group 2, 15 patients, 1975-1982). Abdominal radiation included the entire peritoneal cavity and both diaphragms; the liver was not shielded. Only 2 patients had residual disease greater than 2 cm. No group 1 patients underwent pretherapy restaging laparoscopy prior to radiation or second look laparotomy after treatment. Eighty percent of group 2 patients underwent restaging laparoscopy (10) or staging laparotomy (2) prior to radiation. All group 2 patients underwent second look procedures if no evidence of disease. No patient developed intestinal complications secondary to radiation requiring surgery. Eighty-one percent of group 1 patients and to date 40% of group 2 patients developed recurrences. Size of residual disease prior to radiation, histologic grade, and substage (IIA, B, or C) did not correlate with recurrences. Five-year estimated survival was 40 and 50% for groups 1 and 2, respectively. Three thousand rad of wole abdominal radiation plus 2000 rad pelvic boost or 5000 rad pelvic radiation plus melphalan did not appear to improve survival over surgery alone. The role of radiation therapy in Stage II ovarian cancer remains unclear.

Topics: Adenocarcinoma; Administration, Oral; Adult; Aged; Combined Modality Therapy; Enteritis; Female; Humans; Melphalan; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Ovarian Neoplasms; Radiation Injuries; Radiotherapy