Amelioration of oral mucositis pain by NASA near-infrared light-emitting diodes in bone marrow transplant patients.

PURPOSE: This study seeks to investigate the use of extra-orally applied near-infrared phototherapy for the reduction of oral pain secondary to chemotherapy- and radiation therapy-induced mucositis in adult and pediatric hematopoietic stem cell transplant (HSCT) patients. METHODS: Eighty HSCT patients were divided into regular (R) and low (L) risk groups, then to experimental (E) and placebo (P) groups, resulting in four groups (ER, EL, PR, PL). Experimental subjects received 670 (± 10) nm gallium-aluminum-arsinide light-emitting diode device for 80 s at ~50 mW/cm(2) energy density and power exposure of 4 J/cm(2). Placebo patients received the same procedures, but with a placebo phototherapy (identical device but <5 mW/cm(2) energy density). Patients received their respective light therapy once per day starting on the day of the HSCT (day 0) and continued through day +14. Blinded evaluators examined the patients three times per week and scored their oral tissues and patient-reported pain assessments at each evaluation utilizing the WHO, NCI-CTCAE, and OMAS scales. RESULTS: Analysis of the mean scores at each observation demonstrate that the extra-oral application of phototherapy resulted in a significant reduction in patient-reported pain between the ER and PR patients (p < 0.05) at day +14 when graded via the WHO criteria. The ER and EL patients were improved in almost all other categories and assessment scales, but the differences were not statistically significant. CONCLUSION: Phototherapy demonstrated a significant reduction in patient-reported pain as measured by the WHO criteria in this patient population included in this study. Improvement trends were noted in most other assessment measurements.

Improved outcomes in intermediate- and high-risk aggressive non-Hodgkin lymphoma after autologous hematopoietic stem cell transplantation substituting intravenous for oral busulfan in a busulfan, cyclophosphamide, and etoposide preparative regimen.

Forty-nine patients with intermediate- and high-risk aggressive non-Hodgkin lymphoma underwent autologous hematopoietic stem cell transplantation (autoHSCT) using the regimen of busulfan (Bu), cyclophosphamide (Cy), and etoposide (E) that was originally developed for allogeneic HSCT. Eighteen patients treated before 1999 received Cy 2.5 g/m2 on days -3 to -2 and E 1800 mg/m2 on day -3 after oral (PO) administration of Bu 1 mg/kg every 6 hours x 4 days for a total of 16 doses beginning on day -7. After April 1999, 31 patients similar in all pretransplantation risk assessments received the same regimen except that intravenous (IV) Bu was substituted for PO Bu and pharmacokinetic-directed (PKD) dosing was attempted to achieve an area under the concentration time curve of 1000-1500 micromol/min for each dose. Nonrelapse mortality was 28% for PO Bu patients versus 3% for the IV PKD group (P = .01, chi-square test). Actuarial 5-year overall survivals were 28% for patients who received the PO Bu regimen and 58% for patients who received the IV Bu regimen (P = .010, log-rank test), and progression-free survivals were 17% and 50%, respectively (P = .008, log-rank test). After substitution of PKD IV Bu in the BuCyE regimen, we observed lower nonrelapse mortality with increased overall and progression-free survivals in patients with intermediate- and high-risk aggressive non-Hodgkin lymphoma who underwent autoHSCT.

A limited sampling strategy for pharmacokinetic directed therapy with intravenous busulfan.

High-dose busulfan is widely used in allogeneic and autologous marrow transplantation preparative regimens. Variation in the area under the concentration/time curve (AUC) for oral busulfan results in substantial risk of over or under treatment with excess risk of toxicity or relapse. Use of the IV formulation reduces this variability by eliminating variability in absorption. Variability due to drug metabolism remains, but simplified pharmacokinetic study may be employed to achieve a specific target AUC. In conventional sampling strategies for determining AUC after oral administration, 12 samples are used over 6 hours to assure accurate tracking of erratic absorption. With IV busulfan there is no necessity for measuring plasma levels during the infusion because busulfan pharmacokinetics are well described with a single-compartment, first-order elimination model. In theory, only peak and trough levels should be necessary, but for assurance of reliability in clinical decision making, it must be possible to identify outlier values. This process requires at least 4 samples. We studied a total of 59 adult patients receiving a 2-hour IV busulfan infusion to develop a limited sampling strategy (LSS). At the end of a 2-hour infusion, we collected 11 samples from 18 patients and compared the AUC obtained when all samples were used with the AUC obtained when samples were collected only hourly. The mean AUC calculation was 5% higher (1002 versus 956 microM-min) and the coefficient of variation (CV) was substantially better (4.6% versus 8.2%) when only the postinfusion samples were used. A follow-up study of 41 consecutive patients demonstrated that all patients were easily evaluable with a coefficient of variation (CV) for the AUC of 2.6%. To validate this approach, we analyzed pharmacokinetic data on 60 patients in the phase II clinical trial of the IV formulation described by Anderson et al. Data on an additional 36 patients from a companion study also were analyzed. The AUC based on all 11 samples from each patient were compared with the AUC based on the 5 postinfusion samples. The results of this analysis confirmed comparable reliability and possibly superior precision of the University of Alabama at Birmingham 5-sample LSS. These results validated that LSS for IV busulfan will make possible meaningful and accurate comparisons of busulfan versus TBI-based preparative regimens and comparison of dose intensity of busulfan-containing preparative regimens in trials of submyeloablative transplantation.