Amifostine can reduce mucosal damage after high-dose melphalan conditioning for peripheral blood progenitor cell autotransplant: a retrospective study

Amifostine (WR-2721: Ethyol) is a well-known cytoprotector, but a possible role in preventing extra-haematological toxicity after high-dose therapy (H DT) has never been investigated. We compared two historical groups of patie nts who either received (group A, n = 35) or did not receive (group B, n = 33) amifostine (740 mg/m(2)) before high-dose (HD) melphalan, followed by a utologous infusion of peripheral blood progenitor cells (PBPCs). Amifostine was well tolerated at this dose level. Emesis grade 1-2 was the most impor tant side-effect, but the interruption of infusion was never required. The incidence and median duration of severe mucositis (grade 3-4) was 21% and 0 d (range 0-11 d) in group A and 53% and 7 d (range 0-11 d) in group B. The duration of analgesic therapy was also significantly lower in group A (0 d ; range 0-12) than in group B (6 d, range 0-20) (P = 0.0001). Severe diarrh oea (3% vs. 25%; P = 0.01) and emesis (9% vs. 34%; P = 0.01) were also redu ced in group A in comparison with group B. No differences were observed bet ween the two groups for haematological recovery. This retrospective study s trongly suggests that amifostine can reduce severe mucositis and the use of analgesic drugs in this setting. A randomized study is warranted to confir m these preliminary results.