A prospective study of dysgeusia and related symptoms in patients with multiple myeloma after autologous hematopoietic cell transplantation Journal Article


Authors: Scordo, M.; Shah, G. L.; Adintori, P. A.; Knezevic, A.; Devlin, S. M.; Buchan, M. L.; Preston, E. V.; Lin, A. P.; Rodriguez, N. T.; Carino, C. A.; Nguyen, L. K.; Sitner, N. C.; Barasch, A.; Klang, M. G.; Maloy, M. A.; Mastrogiacomo, B.; Carlow, D. C.; Schofield, R. C.; Slingerland, A. E.; Slingerland, J. B.; Stein-Thoeringer, C. K.; Lahoud, O. B.; Landau, H. J.; Chung, D. J.; van den Brink, M. R. M.; Peled, J. U.; Giralt, S. A.
Article Title: A prospective study of dysgeusia and related symptoms in patients with multiple myeloma after autologous hematopoietic cell transplantation
Abstract: Background: Dysgeusia is a common but understudied complication in patients undergoing autologous hematopoietic cell transplantation (auto-HCT). We assessed the feasibility of using chemical gustometry (CG) to measure dysgeusia and explored its associations with symptom burden, nutrition, chemotherapy pharmacokinetics (PK), and the oral microbiome. Methods: We conducted a single-center, prospective feasibility study (NCT03276481) of patients with multiple myeloma undergoing auto-HCT. CG was performed longitudinally testing five flavors (sweet, sour, salty, bitter, umami) to calculate a total taste score (maximum score, 30). We measured caloric intake and patient-reported symptoms, assessing their correlation with oral microbiota composition and salivary and blood melphalan PK exposure. Results: Among all 45 patients, 39 (87%) completed at least four (>60%) and 22 (49%) completed all six CG assessments. Median total CG scores remained stable over time but were lowest at day +7 (27, range 24–30) with recovery by day +100. Symptom burden was highest by day +10 (area under the curve, 2.9; range, 1.0–4.6) corresponding with the lowest median overall caloric intake (1624 kcal; range, 1345–2267). Higher serum/salivary melphalan levels correlated with higher patient-reported dysgeusia and lower caloric intake. Oral microbiota α-diversity was stable early and increased slightly by day +100. Conclusions: Assessment of dysgeusia by CG is feasible after auto-HCT. Most dysgeusia, symptom burden, and lowest caloric intake occurred during the blood count nadir. Higher melphalan concentrations correlated with more dysgeusia and poorer caloric intake. Future studies will aim to modulate melphalan exposure by PK-targeted dosing and characterize patient taste preferences to personalize diets for improved nutritional intake. Lay summary: Taste changes after cancer treatments are very common. We used chemical gustometry (taste testing) to study taste changes and to better understand why patients with multiple myeloma experience this symptom after autologous hematopoietic cell transplantation. We found that taste testing was feasible, taste changes peaked when blood counts were lowest, and most patients recovered their taste by 100 days after transplantation. Taste changes correlated with lower food intake and with higher levels of chemotherapy in the body. Future work will focus on using personalized chemotherapy doses to reduce taste changes and to match patients' individual taste preferences with their diets. © 2022 American Cancer Society.
Keywords: prospective study; prospective studies; multiple myeloma; melphalan; hematopoietic stem cell transplantation; transplantation, autologous; pharmacokinetics; dysgeusia; hematopoietic cell transplantation; adverse event; complication; autotransplantation; microbiota; humans; human
Journal Title: Cancer
Volume: 128
Issue: 21
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2022-11-01
Start Page: 3850
End Page: 3859
Language: English
DOI: 10.1002/cncr.34444
PUBMED: 36041227
PROVIDER: scopus
PMCID: PMC10010839
DOI/URL:
Notes: Article -- Export Date: 1 November 2022 -- Source: Scopus
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MSK Authors
  1. Sergio Andres Giralt
    1068 Giralt
  2. Heather Jolie Landau
    435 Landau
  3. David Chung
    250 Chung
  4. Molly Anna Maloy
    269 Maloy
  5. Sean McCarthy Devlin
    615 Devlin
  6. Mark G Klang
    29 Klang
  7. Michael Scordo
    387 Scordo
  8. Jonathan U Peled
    158 Peled
  9. Gunjan Lalitchandra Shah
    446 Shah
  10. Oscar Boutros Lahoud
    135 Lahoud
  11. Dean Christian Carlow
    42 Carlow
  12. Andrew Pei-En Lin
    50 Lin
  13. Elaina Vitale Preston
    12 Preston
  14. Andrea Knezevic
    107 Knezevic
  15. Caroline Carino
    3 Carino
  16. Linh Nguyen
    3 Nguyen