Amifostine reduces gastro-intestinal toxicity after autologous transplantation for multiple myeloma. Issue 8 (3rd August 2018)

• Record Type: Journal Article
• Authors: Malek, Ehsan; Gupta, Vinita; Creger, Richard; Caimi, Paolo; Vatsayan, Anant; Covut, Fahrettin; Bashir, Qaiser; Champlin, Richard; Delgado, Ruby; Rondon, Gabriela; Cooper, Brenda; de Lima, Marcos; Lazarus, Hillard M.; Qazilbash, Muzaffar
• Is Part Of: Leukemia & lymphoma. Volume 59:Issue 8(2018)
• Page Start: 1905
• Page End: 1912
• Publication Date: 2018-08-03
• Subjects: Multiple myeloma -- amifostine -- autologous stem cell transplant; Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.1080/10428194.2017.1408086
• Languages: English
• ISSNs: 1042-8194

Abstract

Abstract: High-dose melphalan (HDM) followed by autologous hematopoietic cell transplantation (auto-HCT) remains the standard-of-care therapy for multiple myeloma (MM) even with the availability of proteasome inhibitors and immunomodulatory drugs. Gastrointestinal (GI) toxicity is the main cause of morbidity after HDM. Amifostine, a cytoprotective agent, may reduce HDM-associated GI toxicity. We conducted a case control study comparing HDM + auto-HCT with or without amifostine for MM patients. One hundred and seven patients treated at University Hospitals Cleveland Medical Center who received pre-transplant amifostine were compared to 114 patients treated at MD Anderson Cancer Center without use of this agent. Amifostine 740 mg/m 2 was administered as a bolus infusion at 24 h and 15 min before HDM. Patients' characteristics were similar in both the groups. Amifostine therapy was well tolerated without any significant adverse effects. Grade II or greater oral mucositis (27.1% vs 47.4%; p = .002), nausea (31.8% vs. 86.0%; p = .0001), vomiting (18.7% vs. 52.6%; p = .0001) and diarrhea (56.1% vs. 72.7%; p = .006) occurred less frequently in the amifostine-treated group. There was no discernable effect of amifostine on engraftment, progression-free or overall survival. Our results indicate that amifostine decreases GI toxicity while preserving anti-myeloma efficacy of HDM and auto-HCT.