Effect of oral care models on the prevention of oral mucositis induced by high-doses of melphalan in patients undergoing ASCT

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Abstract
High-dose melphalan (MEL) combined with autologous stem cell transplantation (ASCT) effectively treats multiple myeloma (MM) but often causes oral mucositis (OM), affecting patient outcomes. This study aims to evaluate the effectiveness of an enhanced oral care model in preventing MEL-induced OM. This retrospective study reviewed the medical records of 87 patients with MM who underwent ASCT at the First Affiliated Hospital of Soochow University between December 2019 and February 2022. According to the oral care protocols that had been implemented during their hospitalization, patients were classified into 2 groups: a control group (n = 49) that had received routine oral care and an observation group (n = 38) that had received an enhanced oral care regimen. All patients had received cryotherapy during MEL infusion as part of standard supportive care. The enhanced oral care protocol included prolonged (30-second) gargling with oropharyngeal involvement, cheek puffing exercises, and nurse-supervised education to ensure proper technique and adherence. Relevant clinical data were extracted from medical records, including the incidence, severity, onset, and healing time of OM; pain scores; neutrophil counts; nutritional status; weight change; and length of hospital stay. Baseline characteristics were comparable between groups. The observation group experienced significantly shorter hospital stays and less weight loss ( P < .05). OM onset was delayed, and fewer patients developed OM in the observation group ( P < .05). At OM healing, the observation group had higher neutrophil counts and better nutritional scores ( P < .05). No significant differences were observed in OM pain, severity, or healing duration. Overall, the enhanced regimen improved recovery and reduced OM incidence and impact. However, the retrospective single-center design and limited sample size may restrict the generalizability of these findings, which should be validated in larger prospective studies. Enhanced oral care – incorporating standardized gargling techniques, patient education, and cryotherapy – effectively reduces OM incidence and improves clinical outcomes in MM patients undergoing ASCT. Optimizing oral hygiene protocols may enhance quality of care during high-dose MEL therapy.

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