Neoplasms

Blood and Lymph Conditions

All Conditions

Immune System Diseases

Mouth and Tooth Diseases

Digestive System Diseases

Rare Diseases

Leukemia

Precursor Cell Lymphoblastic Leukemia-Lymphoma

Leukemia, Lymphoid

Stomatitis

Mucositis

Lymphoma

Neoplasms by Histologic Type

Hematologic Diseases

Lymphoproliferative Disorders

Lymphatic Diseases

Immunoproliferative Disorders

Gastroenteritis

Gastrointestinal Diseases

Mouth Diseases

Stomatognathic Diseases

Acute Lymphoblastic Leukemia

Lymphoblastic Lymphoma

Acute Graft Versus Host Disease

Childhood Acute Lymphoblastic Leukemia

Lymphosarcoma

Analgesics

All Drugs and Chemicals

Anti-Infective Agents

Clotrimazole

Miconazole

Antiviral Agents

Antifungal Agents

Seventeen patients will receive treatment using the red wavelength (660 nm) to provide biostimulation. Plus the current protocol (antifungal +/- antiviral and analgesics) used by CCHE which will be recorded in the patient's file.

Seventeen patients will receive treatment using the infrared wavelength (970 nm) to provide biosstimulation. plus the current protocol(antifungal +/- antiviral and analgesics) used by CCHE which will be recorded in the patient's file.

Seventeen patients will receive mock treatment which is the exact repetition of the treatment modality but without any laser emission plus the current protocol(antifungal +/- antiviral and analgesics) used by CCHE which will be recorded in the patient's file

- Laser will be applied with the specified wave length using a diode laser device over 4 consecutive days.

Laser Therapy

Seventeen patients will receive mock treatment which is the exact repetition of the treatment modality but without any laser emission plus the current Protocol(antifungal +/- antiviral and analgesics) used by CCHE which will be recorded in the patient's file

Sham procedure

Ebtesam Hanafy

Hussein ElNoury, MSc

Introduction: Oral mucositis is one of the most frequent complications associated with chemotherapy, occurring in up to 90% children receiving treatment for cancer. Different treatment modalities have been suggested with inconsistent results. Recently, it has been suggested that the use of laser could reduce the grade of oral mucositis and alleviate the symptoms.

Aim: To evaluate and compare the efficacy between the high (Infrared) wavelength laser and low (red) wavelength laser in management of chemotherapy induced oral mucositis in children with acute lymphoblastic leukemia.

Methods: This study is a randomized, prospective, double-blind trial that will include acute lymphoblastic leukemia inpatients receiving induction chemotherapy between the age of 3 and 14years who develop oral mucositis grade 2 or more. These patients will be randomized by the Clinical Epidemiology unit using a computer-based method into three groups. Group I: will be treated with Laser wavelength 660 nm, group II: will be treated with laser wavelength 970 nm, and group III: will receive mock treatment which is the exact repetition of the treatment modality but without any laser emission. All the patients will follow the hospital standard management for oral mucositis. All patients will be assessed for pain score using CHIMES, oral mucositis using NCI-CTCAE scale V5 on days, 0,4,7 and 11. As well as measuring the duration of the lesion.

This study is a randomized, prospective, double-blind trial that will include acute lymphoblastic leukemia inpatients receiving induction chemotherapy between the age of 3 and 14 years who develop oral mucositis grade 2 or more. These patients will be randomized by the Clinical Epidemiology unit using a computer-based method into three groups.

Group I: will be treated with Laser wavelength 660 nm, Group II: will be treated with laser wavelength 970 nm, Group III: will receive mock treatment which is the exact repetition of the treatment modality but without any laser emission.

All the patients will follow the hospital standard management for oral mucositis.

All patients will be assessed for

1. Pain score using CHIMES,
2. Oral mucositis using NCI-CTCAE scale V5 on days, 0,4,7 and 11.
3. Measuring the duration of the lesion.

The outcome evaluator will be a single personnel from the oncology team following up with the case.

Laser Therapy Effect on Oral Mucositis in Childhood Acute Lymphoblastic Leukemia Patients

Effectiveness of Laser Therapy of Different Wavelengths in Chemotherapy Induced Oral Mucositis in Children With Acute Lymphoblastic Leukemia

Assessing the change from baseline pain at day 4. Pain assessment will be done by Children's International Mucositis Evaluation Scale (ChIMES).

For children less than 8 years the guardian will assist the child in filling the chart. Pain will be measured on day 0, 4, 7 and 11

Assessing the change in the Oral Mucositis Severity from baseline at day 4. his will be measured using the National Cancer Institute Common Toxicity Criteria for adverse events (NCI-CTCAE) scale version 5

Children's Cancer Hospital Egypt 57357

Heart and Blood Diseases

Wounds and Injuries

Musculoskeletal Diseases

Multiple Myeloma

Neoplasms, Plasma Cell

Fractures, Bone

Spinal Diseases

Fractures, Compression

Hemostatic Disorders

Blood Coagulation Disorders

Vascular Diseases

Paraproteinemias

Blood Protein Disorders

Hemorrhagic Disorders

Central Nervous System Depressants

Bone Density Conservation Agents

Anesthetics

Anesthetics, General

Diphosphonates

Sham Procedure \& Conservative Treatment

Subjects will be blinded and randomised to Arm 1 and will undergo a general anaesthetic and undergo a sham procedure. They will also be treated under conservative management alone.

Below is a list of the conservative management they will be managed by their Doctor:

1. Bisphosphonates
2. Pain relief
3. Systemic chemotherapy for Myeloma disease
4. Bed rest
5. Radiotherapy
6. Physiotherapy

This is a non interventional as conservative treatment (standard of care for multiple myeloma patients) is used.

Balloon Kyphoplasty \& Conservative Treatment - Interventional Arm

Subjects will be blinded and randomised to Arm 2 (balloon kyphoplasty) and will undergo a general anaesthetic and undergo a balloon kyphoplasty surgical procedure. They will also be treated with conservative management.

Below is a list of the conservative management they will be managed by their Doctor:

1. Bisphosphonates
2. Pain relief
3. Systemic chemotherapy for Myeloma disease
4. Bed rest
5. Radiotherapy
6. Physiotherapy

This is a interventional arm (balloon kyphoplasty procedure) and the patient will receive conservative treatment (standard of multiple myeloma patients) is used.

Arm 2 Balloon Kyphoplasty (Medtronic LCC) and Conservative Treatment

Subjects will be blinded and randomised to Arm 2 and will undergo a general anaesthetic and undergo a balloon kyphoplasty surgical procedure. They will also be treated with conservative management.

Below is a list of the conservative management they will be managed by their Doctor:

1. Bisphosphonates
2. Pain relief
3. Systemic chemotherapy for Myeloma disease
4. Bed rest
5. Radiotherapy
6. Physiotherapy

Arm 2 Balloon Kyphoplasty

Patients recruited to Arm 1 and Arm 2 will undergo conservative management for Multiple Myeloma recommended by their Consultant Hematologist.

* Concomitant treatment with bisphosphonates
* Pain relief as required
* Systemic chemotherapy for Myeloma disease
* Bed rest
* Radiotherapy
* Physiotherapy

Conservative Management

Chara Kyriakou, MD PhD

Sean Molloy, FRCS MSc

The purpose of this study is to determine whether surgical treatment, balloon kyphoplasty is more effective compared to conservative treatment alone (sham procedure) when assessing clinical, translational, radiological \& patient outcomes in patients with multiple myeloma.

Subjects will be recruited to the study if they have VAS score ≥ 6 and has given informed consent to participate in the Melody Study will be randomised to Arm 1 Sham Procedure and Conservative treatment or Arm 2 Balloon Kyphoplasty and Conservative treatment. Subjects recruited to Arm 1 (Sham Procedure and Conservative treatment) can cross over into Arm 2 (Balloon Kyphoplasty and Conservative Treatment) if they have a VAS score ≥ 6 between 8-12 weeks.

Multiple myeloma (MM) accounts for 10% of the malignant haematological diseases and approximately 1% of all cancer-related deaths in Western countries. MM is characterised by the accumulation of malignant plasma cells in the bone marrow leading to impaired haematopoiesis and the highest incidence of bone involvement among the malignant diseases. MM bone disease is the result of increased destruction of bone that cannot be compensated for by new bone formation. Approximately 80% of patients with MM develop skeletal complications including bone pain, hypercalcemia, osteoporosis, osteolytic lesions and pathologic fractures. Vertebral fractures may be associated with spinal cord compression and neurological complications requiring surgery and/or radiotherapy. Osteolytic bone destruction is the most debilitating manifestation of MM, has a severe impact on patients' quality of life and is responsible for increased morbidity and mortality. Furthermore, bone resorption activity has been shown to be an independent risk factor for overall survival in patients with symptomatic MM. Moreover, myeloma-associated lytic bone lesions do not repair, even in patients who are disease free for years.

More than 50% of patients develop vertebral compression fractures (VCFs) either by the time of diagnosis or during the course of the diagnosed disease. These fractures can compromise the spinal cord and patients' height and stature, cause angulation of the spine, increasing sternum pressure, eventually resulting in sternal fractures and compromising the pulmonary capacity. 9% loss in predicted forced vital capacity is associated with each vertebral fracture. Deformity, Insomnia, depression, substantial physical, functional and psychological impairment and ultimately disability can be the result of severe vertebral compression fractures poorly managed at presentation.

Management of spinal MM bone disease

1. Bisphosphonates he use of bisphosphonates, which inhibit bone reabsorption, for the treatment of MM bone disease has led to an improvement in the quality of life for patients with MM.
2. Conservative (non-surgical) management (this is standard of care management for patients with multiple myeloma)

   1. Pain relief
   2. Systemic chemotherapy for Myeloma disease
   3. Bed rest
   4. Radiotherapy
   5. Physiotherapy
3. Standard surgical procedures

A. Open surgical decompression Anterior or posterior decompression and stabilisation through internal fixation hardware and bone grafting (in \<0.5% with gross spinal deformity or neurologic impairment). Higher morbidity and mortality in MM patients because of comorbid conditions related to age, disease associated end-organ damage and immunosuppression B. Minimally invasive - Cement Augmentation

1. Percutaneous Vertebroplasty
2. Percutaneous Kyphoplasty (i.e. Balloon Kyphoplasty)

COST BURDEN, HEALTH ECONOMIC IMPACT AND COST UTILITY ANALYSIS There is little evidence on differences across health systems in choice and outcome of multiple myeloma being treated with conservative treatment, chemotherapy and spinal surgery are three of many treatment options for managing multiple myeloma. The true cost associated with current therapies in addition to supportive care, is significant and poses a tremendous financial burden to both patient and health care providers.

There is therefore a need to begin to systematically optimise the guidance for treatment for this subgroup of patients especially when comparing the two treatment arms in this study, conservative treatment alone versus surgical treatment, balloon kyphoplasty.

This study will determine the cost burden, health economic impact and cost utility analysis by combining the quality of life measurements, the cost analysis will allow a calculation of the relative cost-effectiveness of conservative treatment standard of care versus standard of care plus balloon kyphoplasty.17

RATIONALE FOR CURRENT STUDY

Osteolytic lesions of vertebral bodies are frequent problems in multiple myeloma patients predisposing to severe pain, vertebral fractures and consequent neurological complications.Open surgical procedures to stabilise or correct deformed vertebral bodies are associated with major complications in this group of immunocompromised patients. In addition, open procedures are often not possible, due to a severely impaired strength of the bone tissue, which does not allow the safe application of screws and plates. As a result the standard management to reduce the local pain secondary to vertebral compression fracture has for many years been with pain relief, radiotherapy and the other elements of conservative management listed above. The development of minimally invasive procedures such as kyphoplasty and vertebroplasty has been demonstrated to be an additional effective treatment option to improve mobility and quality of life and to reduce pain.

Percutaneous vertebroplasty involves the injection of acrylic bone cement into the vertebral body in order to relieve pain and/or stabilise the fractured vertebrae and in some cases, restore vertebral height.

Percutaneous Kyphoplasty (or Balloon Kyphoplasty) is performed by inserting a balloon-like device (inflatable bone tamp) through a channel created by a hand drill in the fractured vertebrae. The tamp is positioned and inserted into the vertebral body. The balloon is then inflated slowly until normal height of the vertebral body is restored or the balloon reaches its maximum volume. The procedure is intended to restore vertebral height and correct kyphosis. It may also help to improve pulmonary and gastrointestinal function and reduce the likelihood of subsequent vertebral compression fractures. The inflation of the balloon tamp creates a cavity in the vertebral body so that when the bone tamp is withdrawn, bone cement can be injected into the cavity at a lower pressure, potentially reducing the risk of cement leakage. The cement increases the strength of the vertebra and is intended to provide pain relief.

To Compare Conservative Management Vs. Balloon Kyphoplasty in the Treatment of VCFs in Patients With Multiple Myeloma

Multiple Myeloma Spinal Disease Study; A Multi-centre, Prospective, Single Blinded, Randomized, Controlled Study to Compare Conservative Management Alone Vs. Balloon Kyphoplasty With the Treatment of VCFs in Patients With Multiple Myeloma

Data collected for all intervention groups from the study will be assessed to compare the overall cost of care for conservative management vs. kyphoplasty

Royal National Orthopaedic Hospital NHS Trust

Head of Research Innovation Centre

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Laser Therapy Effect on Oral Mucositis in Childhood Acute Lymphoblastic Leukemia Patients	NCT05452668	Oral Mucositis Childhood Acute...	Laser Therapy Sham procedure	3 Years - 14 Years	Children's Cancer Hospital Egypt 57357
To Compare Conservative Management Vs. Balloon Kyphoplasty in the Treatment of VCFs in Patients With Multiple Myeloma	NCT02732925	Multiple Myelom...	Arm 2 Balloon K... Conservative Ma...	18 Years - 80 Years	Royal National Orthopaedic Hospital NHS Trust
To Compare Conservative Management Vs. Balloon Kyphoplasty in the Treatment of VCFs in Patients With Multiple Myeloma	NCT02732925	Multiple Myelom...	Arm 2 Balloon K... Conservative Ma...	18 Years - 80 Years	Royal National Orthopaedic Hospital NHS Trust
To Compare Conservative Management Vs. Balloon Kyphoplasty in the Treatment of VCFs in Patients With Multiple Myeloma	NCT02732925	Multiple Myelom...	Arm 2 Balloon K... Conservative Ma...	18 Years - 80 Years	Royal National Orthopaedic Hospital NHS Trust

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