Efficacy of keratinocyte growth factor in prevention of oral mucositis in children undergoing allogeneic hematopoietic cell transplantation

Abstract

IntroductionOral mucositis is regarded by patients as one of the worst and debilitating complications of conditioning and hematopoietic cell transplantation (HCT). Prevention of mucositis is one of the priorities of supportive therapy during and after conditioning.ObjectivesThe primary objective of the study was the analysis of efficacy of keratinocyte growth factor (KGF, palifermin) used in prophylaxis of oral mucositis in patients undergoing allo-HCT. The secondary objectives of the study included the analysis of the influence of palifermin on clinical course of oral mucositis and early transplant outcomes, as well as analysis of the contraindications of palifermin in patients undergoing allo-HCT.Patients and methodsA total number of 253 allo-HCT performed between 2003 and 2018 in patients aged 0–19 years in a single center were analyzed. Overall, in 161 HCTs, palifermin was administered.ResultsPatients receiving KGF were transplanted earlier in the context of calendar year, and more often received ATG, mainly due to the higher rate of unrelated donor transplants. Allo-HCT patients who were administered palifermin had shorter time of mucositis (median: 9 vs. 13 days, p < 0.001), lower mucositis grade (median: 2° vs. 3°; p < 0.001), shorter period of total parenteral nutrition (median: 19 vs. 22 days; p = 0.018), and lower incidence of episodes of febrile neutropenia (median: 39.1% vs. 83.1%; p < 0.001).ConclusionsThe use of palifermin has decreased duration and severity of oral mucositis in children after allo-HCT. Palifermin is a safe and well-tolerated compound in children undergoing allo-HCT.

Impact of ferritin serum concentration on survival in children with acute leukemia: a long-term follow-up

“…It was a retrospective study, meaning that other possible factors influencing iron metabolism could not be taken into account [14]. Also, the impact of disease stage and other possible therapy complications [15][16][17][18][19] were not analysed. The validity of the assessment of ferritin as an indicator related to the clinical course of the disease after treatment in paediatric leukemia is debatable, because serum ferritin might normalise during follow-up in some children [20].…”

Acute Lymphoblastic Leukemia in Children: Better Transplant Outcomes After Total Body Irradiation-based Conditioning

“…Busulfan was administered four times a day with age and body weight dose adjustment. Other transplant procedures and supportive care were described elsewhere (11)(12)(13)(14). Neutrophil engraftment was defined as the first of three consecutive days of absolute neutrophil counts exceeding 0.5×10 9 /l.…”

Management of early period of hematopoietic cell transplantation in ambulatory/outpatient setting with primary antimicrobial prophylaxis: an attractive option

“…Antimicrobial prophylaxis for ambulatory auto-HCT patients should be the same as for a conventional inpatient setting [14,15], including antibacterial prophylaxis with quinolones, antiviral prophylaxis with acyclovir (at least up to three months after transplantation) and prophylaxis against Pneumocystis jiroveci with cotrimoxazole; primary antifungal prophylaxis is generally not recommended [3]. Real world data regarding infectious prophylaxis in outpatient auto-HCT studies has been summarized elsewhere [12].…”