Why should I chomp on ice during melphalan treatment?

During the stem cell transplant process, myeloma patients will receive high dose melphalan. Melphalan is a chemotherapy drug that slows the growth of cancer cells and is infused intravenously at clinic typically one to two days prior to receiving stem cells. Melphalan has a variety of side effects, including wreaking havoc throughout the GI tract and causing painful mouth sores. Therefore, it is strongly recommended that patients chew on ice some 20 minutes prior to receiving treatment, during the infusion, and for several minutes afterwards. By doing so, patients can vastly reduce the chances of developing these sores. Chewing on ice can be difficult for many patients. Here are tips:

1. Pack mouth with ice until it melts. Once it does, repeat
2. Chew and swallow ice continually
3. Suck on popsicles without taking a break. Rub the popsicle under tongue and inside cheeks. Keep your mouth as cold as possible
4. Fruit juices or punch can be added to small chunks of ice in a cup to make chewing the ice easier
5. Refrain from talking during this icing phase. Remember, it is imperative to keep the mouth cold prior, during and after melphalan treatment

After infusion, take extra time to practice proper dental care. Brush teeth often with soft bristles. Talk to your doctor about flossing, as it may cause cuts, thereby increasing the risk for bleeding and infection. Keep your mouth as moist as possible. Drink often. Rinse several times throughout the day with a saline solution, Biotene (available at most pharmacies and grocery/convenience stores) or similar. If you do develop painful mouth sores, be sure to inform your doctor.