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Improve the quality of life of chemotherapy patients and prevent oral mucositis-Polyprezinc particles

Improve the quality of life of chemotherapy patients and prevent oral mucositis-Polyprezinc particles

  • Categories:Stomach healthy
  • Author:
  • Origin:
  • Time of issue:2020-12-02
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(Summary description)

Improve the quality of life of chemotherapy patients and prevent oral mucositis-Polyprezinc particles

(Summary description)

  • Categories:Stomach healthy
  • Author:
  • Origin:
  • Time of issue:2020-12-02
  • Views:0
Information

  Preface

  Oral mucositis is one of the most disturbing adverse reactions during cancer treatment, especially in patients with head and neck cancer who have received chemotherapy and patients who have undergone hematopoietic stem cell transplantation (HSCT) after receiving high-dose chemotherapy. Oral mucositis can cause pain and severely reduce the quality of life of patients. Opioid analgesics are needed to relieve pain. In severe cases, it will cause patients to be unable to eat and need to interrupt treatment or reduce the dose of anti-cancer drugs to give complete parenteral nutrition. Oxidative stress and the production of a series of inflammatory cytokines are related to the occurrence of oral mucositis. Studies have shown that the severity of oral mucositis is positively correlated with serum pro-inflammatory cytokines such as TNF-α, IL-1 and IL-6 levels. Mucosal damage develops through five processes: generation of reactive oxygen species; NF-ĸB activation; induction of inflammatory cytokines such as TNF-α, IL-1β and IL-6; TNF-α-mediated ceramide production; cysteine The activation of winter enzymes leads to apoptosis and inflammatory ulcers. Polyprezinc (Polaprezinc, PZ) is a chelate composed of zinc ions and L-carnosine, and is widely used clinically to treat gastric ulcers. Studies have shown that polyprezinc can inhibit the production of inflammatory cytokines such as TNF-α, IL-1 and IL-6, thereby preventing oral mucositis and alleviating pain caused by chemotherapy. This retrospective study aimed to investigate whether polyprezinc (P-AG) suspended in a sodium alginate solution can prevent oral mucositis in patients with hematopoietic malignancies receiving high-dose chemotherapy and HSCT.

  1 Patients and methods

  1.1 Subject

  36 patients (15 years and older) with hematological malignancies received high-dose chemotherapy and radiotherapy after HSCT. The incidence and related symptoms of oral mucositis were reviewed from the medical records of patients hospitalized in Gifu University Hospital from February 2008 to March 2013. There were 25 subjects in the P-AG group; 11 subjects in the control group.

  1.2 Research method

  Suspend 0.5g polyprezinc in 20mL 5% sodium alginate solution to prepare polyprezinc and sodium alginate suspension (P-AG), P-AG group uses P-AG; control group uses glycerin Chrysanthemum blue oral rinsing solution to prevent oral mucositis, pour 7 drops of 4% liquid solution into 100 mL of distilled water to prepare chamomile oral rinsing solution. 4 times a day, oral rinse for 2 minutes, and then swallow; after transplantation lasts for 1 month. 1.3 Assessment of oral mucositis and adverse events The main efficacy indicator is the incidence of oral mucositis, and its maximum severity is assessed within 35 days after the start of chemotherapy. Secondary efficacy indicators are the incidence of pain, dry mouth, and taste disorders, and the reduction of the incidence of pain relief using analgesics. According to the Common Terminology Standard for Adverse Events v3.0 (CTCAE), the incidence of mucositis, pain, xerostomia and dysgeusia were evaluated and the severity was graded. The frequency of using analgesics (including local anesthetics and opioid analgesics) to relieve pain associated with oral mucositis and the incidence of other adverse events between the two groups were compared.

  1.4 Assessment of HSCT transplantation and survival rate

  The implantation time is three consecutive days with an absolute neutrophil count of 500/mm³ or higher. The successful implantation rate of the two groups and the 2-year overall survival rate and recurrence-free survival rate after HSCT were compared.

  1.5 Statistical analysis

  Use the Windows social science statistical program to analyze the data and make statistical comparisons between the two groups. Parametric data were analyzed by t test or chi-square test, and nonparametric data were compared by Mann-Whitney U test or Fisher's exact probability test. p<0.05 is statistically significant.

  2 Results and analysis

  2.1 Demographic information of patients

  There were no significant differences in gender, age, clinical data (excluding total protein), type of leukemia and HSCT between the two groups at the time of entry. The control group had higher total serum protein. There are significant differences in the chemotherapy regimens between the two groups. In the P-AG treatment group, the chemotherapy regimen of cytarabine/fludarabine/cyclophosphamide is the main one, while the control group is combined with cyclophosphamide and cytarabine. Mainly fludarabine, etoposide, busulfan and pridoxime. There was no significant difference in the total body irradiation intensity and the duration of neutropenia (neutrophil count <500/mm³) between the two groups.

  Table I Demographic values ​​represent the mean ± standard deviation, unless otherwise specified; Allo-PBSCT: allogeneic peripheral blood stem cell transplantation; UCBT: unrelated cord blood transplantation; UBMT: unrelated bone marrow transplantation; Ara-C: cytarabine ; CPA: cyclophosphamide; FLU: fludarabine; VP-16: etoposide; BUS: busulfan; L-PAM: melphalan; TBI: whole body radiation; IQR: interquartile range.

  2.2 P-AG reduces the incidence and average grade of oral mucositis

  Compared with the control group, the P-AG group significantly reduced the incidence of grade 2 or higher oral mucositis (82% VS 20%, p<0.01), and decreased by 62%; the incidence of grade 3 and above oral mucositis The rate was 0% (0% VS 45%, p<0.01) (Figure 1A). As shown in Figure 1B, P-AG also significantly reduced the average grade of oral mucositis (p<0.01), from grade 2 to grade 1. Figure 1 Incidence (A) and severity (B) of oral mucositis

  2.3 P-AG reduces moderate to severe pain associated with oral mucositis

  P-AG significantly reduced the incidence of moderate to severe pain (grade 2 or higher) associated with oral mucositis (p=0.004) (Figure 2A). Although the use of opioid analgesics was not significantly different between the two groups (p=0.678), P-AG significantly reduced the use of analgesics (such as local anesthetics) (73% VS 28%, p= 0.678) (Figure 2B). In addition, P-AG can reduce the incidence of xerostomia (p=0.450) and dysgeusia (p=0.697).

  Figure 2 (A) Comparison of the incidence of oral mucositis-related symptoms such as dry mouth, dysgeusia, and pain; (B) Comparison of patients who received high-dose chemotherapy and radiation therapy between P-AG and the control group before undergoing HSCT The use of anesthetics in 2.4 The impact of P-AG on the incidence of other non-hematological adverse events

  There was no significant difference in the incidence of other adverse reactions such as rash, itching, erythema, perianal pain, numbness, nausea, vomiting and coughing between the two groups.

  Table II The incidence of other non-hematological adverse events 2.5 Comparison of HSCT implantation rate and survival rate

  There was no significant difference in the median implantation time between the two groups (p=0.38). In the P-AG treatment group, the successful implantation rate was higher than that in the control group, but it was not significant (p=0.077). There was no significant difference in the two-year overall survival rate (p=0.529) and the two-year relapse-free survival rate (p=0.859) between the two groups.

  Discuss

  Severe oral mucositis is often accompanied by pain, which leads to dietary restriction which seriously affects the quality of life of patients. For patients with hematopoietic malignancies receiving high-dose chemotherapy and HSCT, Polyprezinc can reduce the incidence of oral mucositis by 62%, reduce the severity of oral mucositis, reduce the incidence of moderate to severe pain, and reduce by 45% The use rate of analgesics reduces the incidence of xerostomia and dysgeusia, and increases the rate of HSCT implantation.

  Boda Weiye-Relaisheng (Polyprezinc Granules) is a chelate composed of zinc ions and L-carnosine. It is a mucosal protective agent with dual mechanisms of protection and repair; Relaisant protects mucosa The effect is mainly due to its antioxidant effect and inhibit free radical reaction. At the same time, Relaisen can inhibit the production of inflammatory cytokines such as TNF-α, IL-1 and IL-6, thereby preventing oral mucositis and alleviating radiotherapy and chemotherapy. Pain. It can be seen that polyprezinc not only has a good preventive effect on oral mucositis caused by radiotherapy and chemotherapy of head and neck cancer, but also has a good preventive effect on oral mucositis induced by HSCT after high-dose radiotherapy and chemotherapy, greatly improving patients The quality of life is recommended for widespread clinical use.

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Jilin Province Great Great Pharmaceutical Co. LTD
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Jilin Province Great Great Pharmaceutical Co. LTD
Jilin Province Great Great Pharmaceutical Co. LTD
Jilin Province Great Great Pharmaceutical Co. LTD
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