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A retrospective analysis of polyprezinc to prevent oral mucositis caused by chemotherapy in children

A retrospective analysis of polyprezinc to prevent oral mucositis caused by chemotherapy in children

  • Categories:Stomach healthy
  • Author:
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  • Time of issue:2020-11-18
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(Summary description)

A retrospective analysis of polyprezinc to prevent oral mucositis caused by chemotherapy in children

(Summary description)

  • Categories:Stomach healthy
  • Author:
  • Origin:
  • Time of issue:2020-11-18
  • Views:0
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  Preface

  After radiotherapy and chemotherapy, it is often accompanied by complications such as pain, dysphagia, dysgeusia, dehydration and malnutrition, which severely reduces the quality of life of the patient. Especially for children and adolescents, their basal cell proliferation rate is higher, and the incidence of oral mucositis is about three times that of adult patients. Children who underwent hematopoietic stem cell transplantation (HSCT) after chemotherapy are at a very high risk of severe oral mucositis. A multi-center study composed of 140 children between 6 and 18 years old pointed out that cancer chemotherapy institutes The high symptom burden caused by oral mucositis may have a profound impact on the patient's quality of life and psychological burden. Therefore, prevention and improvement of oral mucositis associated with radiotherapy and chemotherapy is very important for children. Palivumine is a drug to prevent oral mucositis, but due to its lack of long-term follow-up effectiveness and toxicity data, it is recommended for use in pediatric patients. Therefore, the development of oral mucositis prevention drugs related to childhood cancer treatment is imminent. .~Preface

  After radiotherapy and chemotherapy, it is often accompanied by complications such as pain, dysphagia, dysgeusia, dehydration and malnutrition, which severely reduces the quality of life of the patient. Especially for children and adolescents, their basal cell proliferation rate is higher, and the incidence of oral mucositis is about three times that of adult patients. Children who underwent hematopoietic stem cell transplantation (HSCT) after chemotherapy are at a very high risk of severe oral mucositis. A multi-center study composed of 140 children between 6 and 18 years old pointed out that cancer chemotherapy institutes The high symptom burden caused by oral mucositis may have a profound impact on the patient's quality of life and psychological burden. Therefore, prevention and improvement of oral mucositis associated with radiotherapy and chemotherapy is very important for children. Palivumine is a drug to prevent oral mucositis, but due to its lack of long-term follow-up effectiveness and toxicity data, it is recommended for use in pediatric patients. Therefore, the development of oral mucositis prevention drugs related to childhood cancer treatment is imminent. .

  Polaprezinc (Polaprezinc, PZ) is a chelate composed of zinc ions and L-carnosine, and is widely used clinically to treat gastric ulcers. A study showed that polyprezinc and sodium alginate suspension (PZ-AG) is very effective in preventing oral mucositis associated with radiotherapy in adults with head and neck cancer and oral mucositis in adults with high-dose chemotherapy HSCT. However, it is not clear whether PZ-AG can prevent oral mucositis in children with HSCT caused by high-dose chemotherapy. Therefore, this study aims to clarify the effect of PZ-AG on hematological malignancies that undergo HSCT treatment after high-dose chemotherapy. Preventive effect of oral mucositis in children.

  1 Patients and methods

  1.1 Study design and patients

  Retrospective analysis of data obtained from medical records. Sixteen children with hematological malignancies, ranging from 1 to 18 years old, received high-dose chemotherapy from January 2010 to December 2016, followed by autologous peripheral blood stem cell transplantation. Before starting chemotherapy, check whether PZ-AG can be accepted by children. For patients who cannot receive PZ-AG, use chamomile oral liquid to prevent oral mucositis.

  1.2 PZ-AG suspension preparation

  0.5 g of polyprezinc was suspended in 20 mL of 5% sodium alginate solution. After transplantation, gargle with 5 mL of PZ-AG suspension for 2 minutes, 4 times a day, for 1 month, and start using PZ-AG before chemotherapy.

  1.3 Assess oral mucositis and other adverse reactions

  According to the World Health Organization (WHO) Oral Mucositis Grading Scale, the incidence and severity of oral mucositis are evaluated: no oral mucositis symptoms (grade 0), oral pain or erythema (grade 1), oral erythema, Ulcers or patients can eat solid food (level 2), oral ulcers or patients can only eat liquid food (level 3), not oral nutrient solution (level 4).

  The incidence and severity of rash, erythema, nausea, vomiting, and diarrhea were evaluated according to the Common Terminology Criteria for Adverse Reactions (CTCAE) version 4.0. Compare the prevalence of painkillers (including local anesthetics and opioid analgesics) in the chamomile group and the PZ-AG group to relieve the pain associated with oral mucositis.

  1.4 Ethics Statement

  This research was conducted in accordance with the human research guidelines established by the ethics committee of the Gifu University Graduate School of Medicine and the Japanese government, and was approved by the institutional review board. In view of the retrospective nature of the study, informed consent of subjects is not mandatory.

  1.5 Statistical analysis

  The parameter analysis adopts the t test, and the nonparametric analysis adopts the Mann-Whitney u test. The Kaplan-Meier method was used to evaluate the average transplantation time, and the Mantel-Cox log-rank test was used for statistical comparison between the two groups. Data analysis adopts SPSS 22 and GraphPad Prism version 6.0. P<0.05 is statistically significant.

  2 Results and analysis

  2.1 Statistical comparison

  Among the 16 children who met the protocol, 6 (37.5%) refused to take PZ-AG because of bad taste or bad taste, and treated with chamomile oral liquid to prevent oral mucositis (chamomile group). The remaining 10 children (62.5%) took PZ-AG to prevent oral mucositis caused by high-dose chemotherapy (PZ-AG group). Compare the preventive effects of the chamomile group and the PZ-AG group on oral mucositis. As shown in Table 1, there were no significant differences in demographics between the two groups, including gender, age, height, weight, laboratory data, diagnosis, and chemotherapy regimens. Table 1 Demographic data

  2.2 PZ-AG significantly reduces the incidence of oral mucositis

  As shown in Figure 1A, the incidence of grade 1, 2 and 3 oral mucositis: 16.7% (1/6), 50% (3/6) and 33.3% (2/6) in the chamomile group, and the PZ-AG group It is 20% (2/10), 60% (6/10) and 20% (2/10). The incidence of oral mucositis above grade 3 in the PZ-AG group was significantly lower than that in the chamomile group (20% vs 83.3%, P=0.035) (Figure 1B). In addition, the average grade of oral mucositis in the PZ-AG group was significantly lower than that of the chamomile group (2.1 vs 3.7, P=0.037) (Figure 1C). Figure 1 (A) The incidence of all grade 4 oral mucositis; (B) The incidence of oral mucositis ≥ grade 3; (C) The oral cavity of patients with HSCT in the chamomile group and PZ-AG group receiving high-dose chemotherapy and radiotherapy The severity of mucositis.

  2.3 The use rate of analgesics and the average duration of parenteral nutrition (TPN)

  The use rate of opioid analgesics in the PZ-AG group was significantly lower than that in the chamomile group (30% (3/10) vs 100% (6/6), P=0.0113), (Figure 2A). In addition, the average duration of TPN in the PZ-AG group was significantly shorter than that in the chamomile group (11.1 days (95%CI=0-32.7) vs 24.3 days (15.3-34.0), P=0.016) (Figure 2B), while PZ The average period of TPN in the AG group was slightly lower than that of the chamomile group (70% PZ-AG group vs 100% chamomile group).

  2.4 Incidence of non-hematological adverse reactions

  The incidence of other adverse reactions such as rash, gener

  al malaise, nausea, vomiting, and diarrhea, there was no significant difference between the two groups (Table 2).    Table 2 Non-hematological adverse reaction rate

  2.5 HSCT transplantation time and overall survival rate

  Both groups were successfully transplanted. The average transplantation time of the PZ-AG group was 14.7 days shorter than that of the chamomile group (95%CI=9.9-25.8), while that of the chamomile group was 17.2 days (12.2-28.2), HR=1.348 (95%CI=0.394- 4.608), P=0.634 (Figure 3A), there was no significant difference in overall survival between the two groups (HR=0.9862, 95% CI=0.1652-5.877, P=0.9877) (Figure 3B).

  Figure 3 Comparison of HSCT transplantation time and overall survival rate

  Discuss In summary, polyprezinc and sodium alginate suspension (PZ-AG) can effectively reduce the incidence of severe oral mucositis in children with hematological malignancies and reduce the severity of oral mucositis associated with high-dose chemotherapy In addition, it can also reduce the use rate of opioid analgesics, shorten the average use time of TPN and HSCT transplantation time, help prevent oral mucositis caused by high-dose chemotherapy in children, and improve the quality of life of children. Relaisheng-Polyprezinc particles is a chelate compound composed of zinc ions and L-carnosine. Studies have shown that Polyprezinc can inhibit the production of inflammatory cytokines, including TNF-α, IL-1β and IL-6, these are all involved in the pathogenesis of oral mucositis induced by radiotherapy and chemotherapy. Therefore, in addition to the antioxidant effect of polyprezinc, the effect of preventing oral mucositis may benefit from inhibiting the production of inflammatory cytokines. In short, PZ-AG can effectively reduce the incidence of severe oral mucositis in children with hematopoietic malignancies who undergo HSCT after receiving high-dose chemotherapy. It is a new choice for children with cancer chemotherapy.

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