310 Development of a Consistent Approach to the Management Chemo/Radiation Induced Dermatitis in Children Undergoing Allogeneic Stem Cell Transplantation

Track: Contributed Abstracts
Wednesday, February 13, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Nancy Kuntz, RN, PNP , Children's Hospital of Orange County, Orange, CA
Carla Daum, RN, CPON , Children's Hospital of Orange County, Orange, CA
Ivan Kirov, MD , Children's Hospital of Orange County, Orange, CA
Steven Neudorf, MD , Hematology/Oncology, Children's Hospital of Orange County, Orange, CA
Leonard Sender, MD , Oncology, UC Irvine Medical Center, Orange, CA

Blood and marrow transplant program, CHOC Children’s Hospital, Orange CA, and Department of Pediatrics, University of California, Irvine

Background

Radiation dermatitis is a frequent complication following TBI based preparative regimens. There is no consistent approach to the diagnosis and management of radiation dermatitis. Many of the topical therapies have side effects such as skin discoloration and discomfort in the case of silver sulfadiazine. Newer silver containing agents such as Silvasorb gel, Melgisorb Ag® and Mepilex Ag® may facilitate healing and increase patient comfort.

Objective

To develop a consistent approach to diagnosis and management of radiation dermatitis and to assess the clinical outcomes in a pilot study.

Patients

From 2010 to 2012 thirteen patients who underwent allogeneic BMT following a preparative regimen consisting of 1200 cGy fractionated TBI and Cytoxan (60 mg/kg/day x 2 days) were evaluated. All patients received daily topical treatment with a moisturizing barrier cream (Aquaphor). Patients were evaluated daily for dermatitis. Radiation dermatitis was graded according to CTCAE (version 3). Five patients developed radiation dermatitis between days 0 to 2 post transplant.

Treatment and Results

All of the patients were treated according to a previously developed algorithm. Two patients with Grade 2 dermatitis were treated with Silvasorb gel applied twice daily and reinforced with Xeroform gauze. The skin lesions did not progress and was restored by day 5. Three patients who progressed to Grade 3 dermatitis were initially treated with Silvasorb gel, and the treatment was changed to Melgisorb (ag) ®or Mepilex (ag) ®. None of the patients progressed to Grade 4. The skin lesions in all 3 patients with Grade 3 dermatitis was restored by Day 10 post transplant and the therapy was discontinued.

Conclusions

  • CTCAE version 3 for assessing dermatitis represents a useful and consistent tool for defining radiation dermatitis and allows for early intervention.

  • The newer silver containing agents are well tolerated and in this small series, effective in promoting healing.

  • Based on our results an algorithm for early diagnosis and treatment of grade 2-3 radiation dermatitis was established

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