Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Reducing GI Toxicity After Melphalan/Auto-HSCT

Leuk Lymphoma; ePub 2018 Jan 2; Malek, et al

A cytoprotective agent appears to lower GI toxicity and maintain the efficacy of high-dose melphalan (HDM)/autologous hematopoietic cell transplantation (auto-HCT) in patients with multiple myeloma, according to an anlysis involving 221 individuals. Participants had multiple myeloma and were treated at either University Hospitals Cleveland Medical Center with amifostine (740 mg/m2 15 minutes before HDM; n=107) or MD Anderson Cancer Center without the agent. Among the results:

  • Amifostine was well tolerated with no significant adverse effects.
  • ≥Grade II oral mucositis occurred in 27% of patients pre-treated with amifostine, vs 47% of those who were not treated with the agent.
  • Nausea occurred in 32% and 86%, vomiting in 19% and 53%, and diarrhea in 56% and 73%, respectively.
  • Amifostine had no visible effect on engraftment, or progression-free or overall survival.

Commentary:

Malek E, Gupta V, Creger R, et al. Amifostine reduces gastro-intestinal toxicity after autologous transplantation for multiple myeloma. [Published online ahead of print January 2, 2018]. Leuk Lymphoma. doi:10.1080/10428194.2017.1408086.

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