Reducing Gastrointestinal Toxicity After Bone Marrow Transplant for Multiple Myeloma

Pretreatment for patients with multiple myeloma prior to stem cell transplant significantly may reduce the risk of gastrointestinal toxicity without compromising the procedure’s efficacy, according a to new study published in the Leukemia & Lymphoma (online January 2, 2018; doi:10.1080/10428194.2017.1408086).

High-dose melphalan followed by autologous stem cell transplant remains the standard of care for patients with multiple myeloma. However, this treatment is associated with severe gastrointestinal adverse events, including oral mucositis, anorexia, nausea, vomiting, and diarrhea. A common belief is that amifostine—a cytoprotective agent—may reduce high-dose melphalan-related gastrointestinal toxicity.

Ehsan Malek, MD, Case Western Reserve University, and colleagues conducted a study to determine whether amifostine could prevent the gastrointestinal side effects of high-dose melphalan and stem cell transplant.  A total of 107 patients treated at the University Hospitals Cleveland Medical Center who received pre-transplant amifostine were compared with 114 patients treated at MD Anderson Cancer Center without the use of amifostine.

Researchers noted that patient characteristics were similar in both treatment groups.

Results of the comparison showed that the frequency of all-grade oral mucositis, nausea, and vomiting was similar among the two groups. However, fewer patients in the amifostine treatment group had moderate to severe gastrointestinal symptoms.

Eighty-six percent of patients in the non-amifostine group experienced moderate to severe nausea, compared with only 32% of those in the amifostine group. Similarly, oral mucositis, vomiting, and diarrhea were significantly less frequent among patients in the amifostine group.

Furthermore, researchers reported that amifostine did not influence the efficacy of stem cell transplant. Patients in both treatment groups achieved similar overall survival and response rates.

Dr Malek and colleagues concluded that amifostine can be used in the prevention of gastrointestinal adverse events in patients with multiple myeloma undergoing stem cell transplant. “The confirmation of protective effect of amifostine in prospective randomized trials along with a detailed cost analysis may lead to change in practice,” they wrote.—Zachary Bessette

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