Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview

Citation
Nma. Blijlevens et al., Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview, BONE MAR TR, 25(12), 2000, pp. 1269-1278
Citations number
123
Language
INGLESE
art.tipo
Review
Categorie Soggetti
Hematology,"Medical Research Diagnosis & Treatment
Journal title
BONE MARROW TRANSPLANTATION
ISSN journal
0268-3369 → ACNP
Volume
25
Issue
12
Year of publication
2000
Pages
1269 - 1278
Database
ISI
SICI code
0268-3369(200006)25:12<1269:MBIBPC>2.0.ZU;2-A
Abstract
Mucositis is an inevitable side-effect of the conditioning regimens used fo r haematopoietic stem cell transplantation. The condition is better referre d to as mucosal barrier injury (MBI) since it is primarily the result of to xicity and is a complex and dynamic pathobiological process manifested not only in the mouth but also throughout the entire digestive tract. A model h as been proposed for oral MBI and consists of four phases, namely inflammat ory, epithelial, ulcerative and healing phases. A variety of factors are in volved in causing and modulating MBI including the nature of the conditioni ng regimen, the elaboration of pro-inflammatory and other cytokines, transl ocation of the resident microflora and their products, for example, endotox ins across the mucosal barrier, exposure to antimicrobial agents and whethe r or not the haematopoietic stem cell graft is from a donor. Neutropenic ty phlitis is the most severe gastrointestinal manifestation of MBI, but it al so influences the occurrence of other major transplant-related complication s including acute GVHD, veno-occlusive disease and systemic infections. The pathobiology, clinical counterparts and the means of measuring MBI are dis cussed together with potential approaches for prevention, amelioration and, perhaps, even cure.