Fig. 5: Schematic overview of the hypothesised effects of the inflammatory reactions induced by high-dose melphalan.

High-dose melphalan induces a systematic reaction, a mucosal reaction and a reaction in the salivary glands in all patients (uOM and non-uOM). The systemic reaction includes the increase in body temperature and decrease in the leucocytes/neutrophil counts in blood. The mucosal reaction includes oral mucositis and a decreased oral mucosal defence by decreased levels of salivary flow rates, IgA and neutrophil defensin-1 concentrations. Those reactions coincide with the inflammatory reaction in the salivary glands leading to increased lactoferrin concentrations in saliva.