Adverse Effects of Morphine and Fentanyl for Stomatitis in Patients Receiving Allogeneic Hematopoietic Cell Transplantation—A Single Center Retrospective Analysis


Opioids are widely used as analgesics for oral mucositis in allogeneic hematopoietic cell transplantation (allo-HCT). Their main adverse events are nausea, vomiting, constipation, psychological symptoms, and respiratory depression. In our institute, continuous intravenous morphine was generally used until 2007, followed by intravenous fentanyl as the first-line agent because of its potential fewer adverse events. We retrospectively analyzed 99 patients who underwent allo-HCT in the University of Tsukuba Hospital from 2004 to 2009. Out of 99 patients, 64 were treated with opioids (morphine, 32 and fentanyl, 32). The attending physicians were in charge of providing stable pain control. Median age, sex, stem cell source, preparative regimen, and GVHD prophylaxis were similar in the two groups. There were no significant differences in psychological symptoms, drowsiness, nausea, and vomiting in both groups. Defecation ratio (the days having a bowel movement/the days taking opioids) was 63% and 94% in the morphine and fentanyl group, respectively (P < 0.0001). The percentage of patients who needed to use purgative drugs was 25% and 6% in the morphine and fentanyl group, respectively (P = 0.04). It is suggested that fentanyl has less adverse effects on gastrointestinal movement and is safer than morphine when used for oral mucositis in allo-HCT.

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M. Koshino, Y. Okoshi, N. Kurita, N. Obara, K. Suzukawa, Y. Hasegawa and S. Chiba, "Adverse Effects of Morphine and Fentanyl for Stomatitis in Patients Receiving Allogeneic Hematopoietic Cell Transplantation—A Single Center Retrospective Analysis," Open Journal of Blood Diseases, Vol. 2 No. 4, 2012, pp. 81-84. doi: 10.4236/ojbd.2012.24015.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] S. McCann, M. Schwenkglenks, P. Bacon, H. Einsele and A. D’Addio, et al., “The Prospective Oral Mucositis Audit: Relationship of Severe Oral Mucositis with Clinical and Medical Resource Use Outcomes in Patients Receiving High-Dose Melphalan or BEAM-Conditioning Chemotherapy and Autologous SCT,” Bone Marrow Transplant, Vol. 43, No. 2, 2009, pp. 141-147. doi:10.1038/bmt.2008.299
[2] S. R. Fanning, L. Rybicki, M. Kalaycio, S. Andresen and E. Kuczkowski, et al., “Severe Mucositis Is Associated with Reduced Survival after Autologous Stem Cell Transplantation for Lymphoid Malignancies,” British Journal of Haematology, Vol. 135, No. 3, 2006, pp. 374381. doi:10.1111/j.1365-2141.2006.06323.x
[3] P. J. Stiff, H. Erder, W. I. Bensinger, C. Emmanouilides and T. Gentile, et al., “Reliability and Validity of a Patient Self-Administered Daily Questionnaire to Assess Impact of Oral Mucositis (OM) on Pain and Daily Functioning in Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation (HSCT),” Bone Marrow Transplant, Vol. 37, No. 4, 2006, pp. 393-401. doi:10.1038/sj.bmt.1705250
[4] S. Ahmedzai and D. Brooks, “Transdermal Fentanyl versus Sustained-Release Oral Morphine in Cancer Pain: Preference, Efficacy and Quality of Life. The TTS-Fentanyl Comparative Trial Group,” Journal of Pain and Symptom Management, Vol. 13, No. 5, 1997, pp. 254-261.
[5] B. Donner, M. Zenz, M. Tryba and M. Strumpf, “Direct Conversion from Oral Morphine to Transdermal Fentanyl: A Multicenter Study in Patients with Cancer Pain,” Pain, Vol. 64, No. 3, 1996, pp. 527-534.
[6] L. Radbruch, R. Sabatowski, G. Loick, C. Kulbe and M. Kasper, et al., “Constipation and the Use of Laxatives: A Comparison between Transdermal Fentanyl and Oral Morphine,” Palliative Medicine, Vol. 14, No. 2, 2000, pp. 111-119.
[7] A. Herz and H. J. Teschemacher, “Activities and Sites of Antinociceptive Action of Morphine-Like Analgesics,” In: N. J. Harper and A. B. Simmonds, Eds., Advances in Drug Research, Academic Press, London, 1971, pp. 79121.

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