Mori, T., Hasegawa, K., Okabe, A., Tsujimura, N., Kawata, Y., Yashima, T., … Okamoto, S. (2008). Efficacy of mouth rinse in preventing oral mucositis in patients receiving high-dose cytarabine for allogeneic hematopoietic stem cell transplantation. International Journal of Hematology, 88, 583–587.

To determine efficacy of an icy mouth rinse during the administration of cytarabine

Patients were instructed to rinse the mouth with ice-cold water every 10 minutes during the two-hour cytarabine infusion and for one hour after completion of cytarabine infusion. At each time, patients were instructed to rinse the mouth three times. Oral mucositis grading was evaluated daily from the day treatment began to day 28 post-transplant or until complete resolution of mucositis. Maximum grades were used in analysis.

• The study reported on 15 patients. These patients were compared to 35 historical controls.
• Median age of patients was 50 years, with a range of 31–57 years. In the historical control group, the median age of patients was 40 years, with a range of 20–56.
• The sample was 46% female and 54% male.
• All were patients undergoing allogeneic stem cell transplant with a conditioning regimen of total body irradiation and high-dose cytarabine.

The study was conducted at a single-site inpatient setting in Tokyo, Japan.

This was a prospective trial with comparison to historical controls.

The National Cancer Institute common toxicity criteria grading for mucositis was used.

Incidence of grade 2 mucositis  (p = 0.009) and grade 3 mucositis (p = 0.02) was significantly lower in patients who used the mouth rinse compared to the historical controls.

Findings suggest that the cytarabine excreted into saliva contributes to high-dose, cytarabine-induced oral mucositis. Approaches such as mouth rinsing may remove this from the oral cavity and help in the prevention of severe mucositis. How the temperature of the rinse may influence effects is not known.

• The sample size was small with fewer than 30 patients.
• This was not a prospective study.
• No appropriate control or comparison group was included.

Use of ice water rinses during chemotherapy infusion is a simple intervention that might be helpful for prevention of oral mucositis. Well-designed research in this area is warranted, and application and timing of use with other chemotherapeutic agents needs to be examined.