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| |  Oral Mucositis More Frequent in Obese Patients With Multiple Myeloma on Melphalan Therapy: Presented at ASH By Ed Susman NEW ORLEANS -- December 10, 2009 -- Researchers suggested here at the American Society of Hematology (ASH) 51st Annual Meeting and Exposition that patients diagnosed with multiple myeloma may suffer more from mucositis if they are obese when compared with normal weight individuals. Dan Vogl, MD, University of Pennsylvania, Philadelphia, Pennsylvania, said that obesity -- measured body fat percentage -- was associated with increases in oral mucositis independent of the dose of melphalan or a person’s weight or kidney functioning. “High dose melphalan followed by an autologous peripheral blood stem cell transplant is standard initial therapy in multiple myeloma,” said Dr. Vogl during his poster presentation on December 6. “However, toxicity and efficacy of this treatment are variable.” Dr. Vogl and colleagues set out to determine if there were conditions that made a person more susceptible to toxic events, focusing on the roles of obesity and renal functioning. They followed outcomes in 39 patients (median age, 55 years) who underwent the melphalan-based treatment followed by transplantation. Two days prior to the stem cell transplantation, patients were treated with melphalan 200 mg/m2, although 1 person with renal insufficiency was treated with 180 mg/m2. The percentage of body fat was measured with dual energy x-ray absorptiometry scans. The researchers also monitored glomerular filtration rate. In the multivariate analysis, for every 10 percentage points of body fat, there was a 0.65-point increase in the Oral Mucositis Assessment Score. In the 0 to 5 scale, higher scores indicated a worsening effect. That increase was statistically significant (P = .01). Similarly changes in the peak soreness score increased by 2.07 points for every 10% increase in body fat content (P = .05). The soreness score was calculated from the area under the soreness curve from information collected on the M. D. Anderson Symptom Inventory. “The effect of obesity is present with both objective and subjective mucositis scores,” said Dr. Vogl. He said there was no clear relationship between obesity and either diarrhoea or overall symptoms. He said the study suggests that following high-dose melphalan treatment renal insufficiency might be correlated with worse mucositis. “We are measuring pharmacokinetics in this group of patients to determine whether obesity or renal function directly affect melphalan distribution or clearance,” Dr. Vogl said. “Further research should help guide rational chemotherapy dosing for this highly effective treatment,” he said. Funding for this study was provided by the Leukemia and Lymphoma Society, the Abramson Cancer Center at the University of Pennsylvania, and the National Center for Research Resources. [Presentation title: Effect of Obesity and Renal Insufficiency on Toxicity of High-Dose Melphalan for Multiple Myeloma. Abstract 1177]
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