Effect of a supersaturated calcium-phosphate rinse on oral mucositis in patients undergoing hematopoietic stem cell transplantation (HSCT): a systematic review and meta- analysis

Abstract Background Oral mucositis (OM) is a common complication of hematopoietic stem cell transplantation (HSCT). OM is very painful, influences nutritional intake and impairs patients’ quality of life (QoL). Although several studies have investigated the potential of supersaturated calcium-phosphate rinse (SCPR) in reducing the incidence, duration and severity of OM in patients undergoing HSCT, conclusive results have not yet been found. Therefore, the aim of this systematic review and meta-analysis is to comprehensively evaluate whether SCPR is effective in reducing the incidence, duration and severity of HSCT-induced OM. Methods Five electronic databases were searched: PubMed, EMBASE, the Cochrane Library, CINAHL and Google Scholar up to August 2021. Both randomized controlled trials (RCTs) and non-randomized studies of interventions (NRISs) were included. Two reviewers independently screened titles, abstracts and full texts for study inclusion, and extracted data from the included studies. We used the RoB 2 and ROBINS-I to critically appraise the included studies, and GRADE to assess the quality of evidence. Results Out of 1008 publications, 8 RCTs and 3 NRSIs with in total 830 participants, were included. Meta-analyses showed that SCPR did not decrease the incidence of OM: 3 studies (RR, 0.93; 95% CI, 0.80–1.08), moderate severe OM: 2 studies (RR, 1.16; 95% CI, 0.85–1.59) and severe OM: 2 studies (RR, 0.66; 95% CI, 0.27–1.64). Meta-analysis was not possible for the duration of OM due to heterogeneity between the studies.The overall quality of evidence was moderate for the incidence of OM and low for the duration and severity of OM. Conclusions Based on the available evidence, SCPR does not seem effective in reducing the incidence, duration and severity of OM in patients undergoing HSCT. Further large-scale studies with more rigorous methodology are required to enhance the quality of evidence.