Journal Article

Palifermin is efficacious in recipients of TBI-based but not chemotherapy-based allogeneic hematopoietic stem cell transplants

Goldberg, J D, Castro-Malaspina, H, Perales, M-A, van den Brink, M R M, Zheng, J, Jakubowski, A A, Heller, G

2013

Overview

Palifermin, a recombinant human keratinocyte growth factor, is commonly given to prevent mucositis following autologous transplantation. In the allogeneic hematopoietic stem cell transplant (allo-HSCT) setting, safety and efficacy data are limited. We conducted a retrospective study in 251 patients undergoing allo-HSCT, 154 of whom received peritransplant palifermin. In all patients, palifermin significantly decreased the mean number of days of total parenteral nutrition (TPN, 13 vs 16 days, P =0.006) and patient-controlled analgesia (PCA, 6 vs 10 days, P =0.023), as well as the length of initial hospital stay (LOS, 32 vs 37 days, P =0.014). However, the effect of palifermin was only significant in patients who received a TBI- but not BU-based chemotherapy conditioning regimen. In TBI recipients, palifermin decreased the mean number of days of TPN (13 vs 17 days, P <0.001) and PCA (7 vs 12 days, P =0.033), and the length of stay (32 vs 38 days, P =0.001). Palifermin did not affect GVHD, graft failure or relapse. Therefore, in the largest analysis with this patient population to date, we demonstrate that palifermin is safe in allo-HSCT patients, decreases TPN and PCA use and decreases LOS following TBI-based but not chemotherapy-based allo-HSCT.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 631/250/1904 / 631/532/1542 / 692/699/1503 / 692/700/565/1436/99 / Adult / Aged / Analgesia / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Antineoplastic Agents - adverse effects / Antineoplastic Agents - pharmacology / Autografts / Biological and medical sciences / Bone marrow / Bone marrow transplantation / Bone marrow, stem cells transplantation. Graft versus host reaction / Cell Biology / Chemotherapy / Cohort Studies / Data processing / Dosage and administration / Female / Fibroblast Growth Factor 7 - adverse effects / Fibroblast Growth Factor 7 - genetics / Fibroblast Growth Factor 7 - therapeutic use / Follow-Up Studies / Gastrointestinal Tract - drug effects / Gastrointestinal Tract - physiopathology / Gastrointestinal Tract - radiation effects / Graft-versus-host reaction / Grafts / Health aspects / Hematology / Hematopoietic Stem Cell Transplantation - adverse effects / Hematopoietic stem cells / Hospitals / Humans / Incidence / Internal Medicine / Keratinocyte growth factor / Male / Medical sciences / Medicine / Medicine & Public Health / Middle Aged / Mucositis / Mucositis - epidemiology / Mucositis - etiology / Mucositis - physiopathology / Mucositis - prevention & control / New York City - epidemiology / original-article / Pain perception / Palifermin / Parenteral nutrition / Prevention / Protective Agents - adverse effects / Protective Agents - therapeutic use / Public Health / Radiotherapy / Recombinant Proteins - therapeutic use / Rejection / Retrospective Studies / Risk factors / Severity of Illness Index / Stem cell transplantation / Stem Cells / Survival Analysis / Transfusions. Complications. Transfusion reactions. Cell and gene therapy / Transplantation / Transplantation Conditioning - adverse effects / Transplantation Conditioning - methods / Transplantation, Homologous / Whole-Body Irradiation - adverse effects / Young Adult