Mucositis involving the gastrointestinal, vaginal, and nasal mucosa is one of the primary dose-limiting toxicities of hematopoietic stem cell transplantation (HSCT) and its conditioning regimen. The oropharyngeal mucosa is commonly affected, which can be detrimental to patient health and quality of life. Despite its significant prevalence and deleterious effects, we have an inadequate understanding of the risk factors and outcomes associated with oral mucositis (OM). We performed a literature search through PubMed and EBSCO (inception to 31 March 2024) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data was extracted from eligible studies using a pre-specified data extraction form. Quality of the data was assessed using the Newcastle-Ottawa Scale for non-randomized, observational studies and the Cochrane Collaboration Tool for randomized controlled trials. Our initial search identified 1677 articles, 34 of which were included in our study. Of those 34, 30 were included in the qualitative assessment of clinical risk factors in the development of OM, and 4 were included in the meta-analysis assessing the relationship between OM and infectious complications following HSCT. Across both HSCT modalities and cancer cohorts, female sex and high-intensity conditioning were common risk factors in the development of OM. When stratified by allogeneic and autologous HSCT, methotrexate, younger age, and longer duration of neutropenia were associated with increased OM risk in allogeneic HSCT recipients, while renal dysfunction, HSV-1 reactivation, and longer neutrophil engraftment were associated with increased OM risk in autologous HSCT recipients. Longer neutrophil engraftment was a common risk factor across different cancer cohorts; however, renal dysfunction was a distinct risk factor for OM in multiple myeloma patients. Additionally, our meta-analysis revealed that patients with OM have an increased risk of developing infectious complications following HSCT compared to those without OM, with an odds ratio of 3.84 (95% CI: 2.51–5.86). The development of OM is related to various risk factors, and individuals with OM are at greater risk of infectious complications. Knowledge of these risk factors and outcomes will help clinicians identify high-risk individuals, prevent OM, and protect an immunocompromised population from subsequent life-threatening complications.
黏膜炎累及胃肠道、阴道及鼻腔黏膜，是造血干细胞移植及其预处理方案的主要剂量限制性毒性之一。口咽黏膜常受累，可能对患者健康及生活质量造成损害。尽管其发病率高且危害显著，目前对口咽黏膜炎相关危险因素及临床结局的认识仍不充分。本研究遵循系统综述与荟萃分析优先报告条目指南，通过PubMed和EBSCO数据库（建库至2024年3月31日）进行文献检索。采用预设数据提取表从符合条件的研究中提取数据，非随机观察性研究使用纽卡斯尔-渥太华量表评估质量，随机对照试验采用Cochrane协作网偏倚风险评估工具。初步检索获得1677篇文献，最终纳入34项研究。其中30项用于口咽黏膜炎临床危险因素的定性评估，4项纳入评估口咽黏膜炎与移植后感染并发症关系的荟萃分析。在不同移植模式和癌症队列中，女性性别及高强度预处理是口咽黏膜炎的常见危险因素。按异基因与自体移植分层分析显示：异基因移植受者中甲氨蝶呤使用、年龄较小及中性粒细胞减少持续时间延长与口咽黏膜炎风险增加相关；自体移植受者中肾功能不全、HSV-1再激活及中性粒细胞植入时间延长与风险增加相关。中性粒细胞植入时间延长是各癌症队列的共有危险因素，而肾功能不全在多发性骨髓瘤患者中具有特异性风险提示作用。此外，荟萃分析显示口咽黏膜炎患者移植后发生感染并发症的风险显著高于无口咽黏膜炎者（比值比3.84，95%置信区间：2.51–5.86）。口咽黏膜炎的发生与多种危险因素相关，且患者更易发生感染并发症。明确这些危险因素与临床结局将有助于临床医师识别高危人群、预防口咽黏膜炎发生，从而保护免疫功能低下人群免于后续危及生命的并发症。
肿瘤(癌症)患者之家