A supersaturated solution of calcium and phophate (Caphosol®) for prevention of oral mucositis in paediatric stem cell recipients

Orointestinal mucositis (OM) is frequently encountered in children receiving high dose chemotherapy and/or radiation for stem cell transplantation. Not only a risk factor for life threatening infections due to disruption of the mucosal barrier, it is also responsible for prolonged hospitalization owed to severe pain requiring systemic analgetics or parenteral nutrition. The prevention and treatment of transplant-related OM in children depends on compliance and includes various approaches. Caphosol® (EUSA Pharma), a supersaturated solution of calcium and phosphate has been introduced as mouth rinse for prevention of OM in adults with promising results. To the best of our knowledge, no data have yet been reported for its use in pediatric patients. We therefore assessed the feasibility of administering Caphosol® mouth rinse in children > 5 years. Five female and 9 male patients (age: 5.8 to 28.3 years, median age: 12.0 years) receiving stem cell transplantation for malignant or nonmalignant diseases at our hospital were enrolled into a pilot study using Caphosol® to prevent OM. Administration lasted from conditioning until OM resolved. The number of daily applications, adverse effects related to its use (nausea, vomiting, pain or paresthesia due to the mouth rinse) and the severity of OM were recorded. With extensive support from nurses, most patients were able to administer the mouth rinse accordingly. A median of 2.9 applications per day (range: 0 to 5) were used throughout a median of 28.5 days (range: 3 to 49 days). Three patients (21.4%) prematurely abandoned the mouth rinse due to extended nausea or vomiting (n=2) and intensive care treatment for respiratory failure not related to the mouth rinse (n=1). Side effects observed during the application period were nausea, vomiting and pain >grade 3 (>3cm on a 10cm visual analogue scale) through a median of 3.5, 2 and 5 days respectively. One patient experienced prolonged salty taste. We conclude that Caphosol® mouth rinse is a feasible and acceptable method to prevent chemotherapy or radiation associated OM in children > 5years. It was generally well tolerated and no major side effects were observed. However, randomized studies are warranted to clarify if Caphosol® is superior to other strategies for prevention of OM in children receiving stem cell transplantation.