Amifostine reduces mucosal damage after high-dose melphalan conditioning and autologous peripheral blood progenitor cell transplantation for patients with multiple myeloma.
High-dose melphalan (HDM) has been adopted as standard therapy in the treatment of multiple myeloma. This treatment is associated with non-selective cytotoxicity, causing oral mucositis as the major non-hematological side-effect. Amifostine is a cytoprotector which prevents toxicity induced by anticancer therapy. We prospectively compared two groups of patients who either received (group A, n = 21) or did not receive (group B, n = 20) amifostine (740 mg/m(2)) before HDM (200 mg/m(2)) followed by autologous peripheral blood progenitor cell transplantation. The occurrence of severe oral mucositis was significantly decreased in group A in comparison to group B (33% vs 65%, P < 0.05). Six patients in group A required opioid analgesic therapy during a mean period of 4.8 days as compared to eight patients for 6.5 days in group B (P = NS). Delayed vomiting was less frequent in group A (43% vs 70%, P = 0.07) and significantly less severe in group A (grade 2-4) vomiting: two patients vs nine patients, P < 0.02). No difference was observed between the two groups in either hematological toxicity after HDM or in response rate. Grade I emesis was the only immediate side-effect observed after amifostine administration. We conclude that amifostine can reduce mucositis induced by HDM.
Thieblemont
C
C
Haematology Department, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
Dumontet
C
C
Saad
H
H
Roch
N
N
Bouafia
F
F
Arnaud
P
P
Hequet
O
O
Espinouse
D
D
Salles
G
G
Roy
P
P
Eljaafari-Corbin
A
A
Du Manoir-Baumgarten
C
C
Coiffier
B
B
D000328:Adult; D000368:Aged; D004999:Amifostine / Q000008:administration & dosage / Q000494:pharmacology* / Q000633:toxicity; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000633:toxicity*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007700:Kinetics; D008297:Male; D008558:Melphalan / Q000633:toxicity; D008875:Middle Aged; D009061:Mouth Mucosa / Q000187:drug effects; D009101:Multiple Myeloma / Q000150:complications / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D013280:Stomatitis / Q000139:chemically induced* / Q000517:prevention & control; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D004999:Amifostine; D008558:Melphalan