Amifostine in Reducing GI Toxicity in Myeloma Patients After Marrow Transplant
Research published in Leukemia & Lymphoma suggests that patients with multiple myeloma treated with amifostine prior to standard high-dose melphalan (HDM) and subsequent autologous hematopoietic cell transplantation may experience fewer gastrointestinal (GI) side effects than those who did not receive pretreatment. The study, led by Ehsan Malek, MD, of Case Western Reserve University Hospital in Cleveland, and colleagues, indicates amifostine may decrease severe GI toxicity without impacting the benefits of HDM and stem cell transplantation.
“The confirmation of [the] protective effect of amifostine in prospective randomized trials along with a detailed cost analysis may lead to change in practice,” the authors predicted.
A total of 107 patients from the University Hospitals Cleveland Medical Center received a bolus infusion of amifostine 24 hours and 15 minutes prior to standard HDM and transplantation. The treatment group was compared with 114 control patients treated at MD Anderson Cancer Center who did not receive pretreatment. The patient characteristics were similar in both cohorts.
Amifostine therapy significantly reduced severe GI adverse effects in patients in the treatment pool versus the control group, including grade 2 or greater oral mucositis (27.1% vs 47.4%), nausea (31.8% vs 86.0%), vomiting (18.7% vs 52.6%), and diarrhea (56.1% vs 72.7%). In addition, progression-free survival was significantly longer in the treatment group at 40 months than in the control group at 32 months (P = .012). There was no significant difference in overall survival between the two cohorts.