Supersaturated Calcium Phosphate Rinse in Preventing Oral Mucositis in Young Patients Undergoing Autologous or Donor Stem Cell Transplant

• Incidence of severe oral mucositis (WHO Grade 3 or 4) [ Designated as safety issue: Yes ]
• Severity of mucositis according to pain categorical rating scale and modified OMDQ [ Designated as safety issue: Yes ]
• Incidence, total dose, and duration of parenteral opioid analgesic use [ Designated as safety issue: No ]
• Incidence and duration of TPN use [ Designated as safety issue: No ]
• Incidence of febrile neutropenia [ Designated as safety issue: No ]
• Incidence of invasive bacterial infections [ Designated as safety issue: No ]
• ChIMES score [ Designated as safety issue: No ]

RATIONALE: Supersaturated calcium phosphate (Caphosol) rinse may be able to prevent mucositis, or mouth sores, in patients undergoing stem cell transplant.

PURPOSE: This randomized phase III trial is studying how well Caphosol rinse works in preventing mucositis in young patients undergoing autologous or donor stem cell transplant.

OBJECTIVES:

Primary

• To determine if topically administered supersaturated calcium phosphate (Caphosol), rinsed orally four times daily at the initiation of conditioning for hematopoietic stem cell transplantation (HSCT), reduces oral mucositis as demonstrated by a decrease in duration of severe oral mucositis (World Health Organization [WHO] Grade 3 or 4), compared to placebo.

Secondary

• To determine whether Caphosol administration, when compared to placebo, reduces oral mucositis as demonstrated by a decrease in incidence of severe oral mucositis (WHO Grade 3 or 4); severity of mucositis according to mouth pain categorical rating scale and Oral Mucositis Daily Questionnaire (OMDQ); incidence, total dose, and duration of parenteral opioid analgesic use (morphine equivalents); and incidence and duration of total parenteral nutrition (TPN) administration.
• To determine whether Caphosol administration, when compared to placebo, reduces the incidence of febrile neutropenia and invasive bacterial infections.
• To validate a new pediatric measure of oral mucositis termed the Children's International Mucositis Evaluation Scale (ChIMES).

OUTLINE: This is a multicenter study. Patients are stratified according to conditioning regimen (total-body irradiation [TBI] or melphalan vs neither TBI nor melphalan) and hematopoietic stem cell transplantation (HSCT) (autologous vs allogeneic). Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients rinse and gargle with supersaturated calcium phosphate rinse over 1 minute four* times daily beginning on the first day (about day -7) of the conditioning regimen.
• Arm II: Patients rinse and gargle with placebo over 1 minute four* times daily beginning the first day (about day -7) of the conditioning regimen.
• NOTE: * Patients who reach WHO grade 3 or 4 mucositis have the option to request a total of 6 rinses daily.

In both arms, treatment continues until day 20 post-transplantation OR until mucositis resolves to WHO Grade ≤ 2 for two consecutive days OR on day 12 in patients who do not experience oral mucositis of at least WHO Grade ≥ 1.

Patients are assessed daily by trained healthcare professionals using the Oral Mucositis Daily Questionnaire (OMDQ), the Pain Rating Scale, the WHO Mucositis Scale, and the Children's International Mucositis Evaluation Scale (ChIMES) from day -1 and continuing until day 20. Patients are also observed for the incidence of total dose and duration of parenteral opioid analgesic use, duration of total parenteral nutrition (TPN) administration, febrile neutropenia, and invasive bacterial infections.

After completion of study therapy, patients are followed up for 30 days.

• Bacterial Infection
• Mucositis
• Neutropenia

• Drug: supersaturated calcium phosphate rinse
  Mouth rinse
• Other: placebo
  Mouth rinse

• Experimental: Arm I
  Patients rinse and gargle with supersaturated calcium phosphate rinse over 1 minute four times daily on days -7 to 20.
  Intervention: Drug: supersaturated calcium phosphate rinse
• Placebo Comparator: Arm II
  Patients rinse and gargle with placebo over 1 minute four times daily on days -7 to 20.
  Intervention: Other: placebo

DISEASE CHARACTERISTICS:

• Patients undergoing myeloablative autologous or allogeneic hematopoietic stem cell transplantation (HSCT) for any indication

• One or more of the following donor stem cell sources (autologous or allogeneic):

  • Bone marrow
  • Placental blood (umbilical cord blood)
  • Cytokine-mobilized peripheral blood

• Patients eligible for allogeneic HSCT must have one of the following sources of donor stem cells:

  • HLA-matched family member
  • Partially matched family member (mismatched for a single HLA locus at A, B, C, or DR)
  • Fully HLA-matched or partially mismatched unrelated marrow or peripheral blood stem cell donor (per institutional donor selection standards)
  • HLA-matched or partially mismatched (at least 4 of 6 match at A, B, DR) cord blood

• Patients expecting to receive any type of myeloablative HSCT conditioning regimen are eligible

  • No non-myeloablative or reduced-intensity conditioning regimens

PATIENT CHARACTERISTICS:

• Not pregnant or nursing
• Negative pregnancy test
• Patients must use an effective birth control method

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• No palifermin within the past 30 days
• No prior supersaturated calcium phosphate (Caphosol) rinse
• No concurrent intravenous palifermin, topical glutamine, or Gelclair