Utilizing Cryotherapy for Patients Receiving Busulfan As Preparative Therapy for HSCT

Emerging literature from the Oncology Nursing Society suggests that cryotherapy may serve as an effective prophylactic intervention for the treatment of mucositis , specifically following the administration of Busulfan for allogeneic hematopoietic stem cell transplant conditioning. The team at St. David's South Austin Medical Center (SDSAMC) is interested in evaluating the efficacy of cryotherapy in mitigating mucositis within our own clinical practice. This investigation aims to optimize patient outcomes and enhance overall transplant tolerability . To better understand the number of patients that had received Busulfan at SDSAMC, a comprehensive chart review was completed including patient diagnosis, conditioning regimen, Busulfan AUC dose, age and pre-transplant comorbidities. Between 2016 and 2024, 52 patients received a Busulfan-containing conditioning regimen. There were 11 females and 41 males with most common indications for treatment being for AML and MDS. Knowing a significant number of patients had received a Busulfan containing regimen, a multidisciplinary team decision was made to explore cryotherapy. A questionnaire was utilized for patient reported outcomes (PRO) (PLoS One, 2014) and a list of upcoming patients was formulated. Patients were asked to participate in the utilization of cryotherapy to minimize the risk of mucositis. Patients were instructed to initiate cryotherapy 90 minutes into a three-hour infusion with the peak distribution timing as outlined by the Oncology Nursing Society (Oncology Nursing Forum, 2022). Cryotherapy was continued for a duration of 120 minutes to the extent feasible for each patient. Nursing staff documented the initiation time, duration, and patient tolerance of cryotherapy within the chemotherapy notes. Subsequently, patients were asked to complete a seven-question questionnaire where they rated their mucositis symptoms on a scale of 0 to 5 (Figure 1.). These assessments were conducted on Day 0, Day +7, Day +14 and Day +21. The analysis of these patients included an evaluation of the PROs, area under curve (AUC) dose, the max grade of mucositis as performed using the WHO criteria, the need for interventions i.e. patient controlled analgeisia (PCA), IV or oral analgesics, and discharge date. To date, 3 patients have been treated using cryotherapy (Figure 2.). While the sample size is small, SDSAMC will continue treat a larger size and utilize retrospective data to determine the overall impact to patients. The goal would be to see a reduction in the WHO mucositis grading score, decreased use of IV or oral analgesics and PCA pumps, and potentially shortened hospital stays.