Palifermin reduces infection rate and hyperfibrinogenemia in patients treated with high-dose chemotherapy based on beam or BU-thiothepa

Abstract

We performed a retrospective study in patients who underwent high-dose chemotherapy and auto-SCT because of haematological malignancies. Forty patients were treated with palifermin while 80 were controls selected after being matched for diagnosis and length of neutropenia. Patients treated with BEAM or BU-CY or THIO-CY (BEAM/BUS) displayed, after palifermin, a lower rate of severe oral mucositis (P = 0.03). This beneficial effect of palifermin was not evident in the stratum of patients treated with high-dose melphalan (HD-PAM). After palifermin, we observed in the whole treated population a reduced rate of 'fever of unknown origin' (FUO, P = 0.02) and of severe infections not related to Gram-positive bacteria (FUO, Gram-negative bacteremia or pneumonia) (P = 0.003). This effect of palifermin on infections not related to Gram-positive bacteria was evident only in patients receiving BEAM/BUS (P = 0.01) and not in patients treated with HD-PAM (P = 0.11). Fibrinogen peak in plasma was found to be reduced after palifermin in the whole population (P = 0.01) and in the stratum who received BEAM/BUS (P = 0.02) but not in the stratum of HD-PAM. In conclusion, antiinfectious beneficial effects of palifermin are more evident in BEAM/BUS-treated patients and toward some types of infections. Reduction of fibrinogen level after palifermin suggests that this agent reduces not only the rate of infections but also their severity.

Immune reconstitution post allogeneic transplant and the impact of immune recovery on the risk of infection

“…45 Another retrospective study reported that in patients undergoing BEAM (carmustine, etoposide, cytarabine and melphalan) or busulfan-thiotepa conditioned autologous HCT, treatment with palifermin is associated with a lower risk of febrile neutropenia and severe infections not related to gram-positive organisms. 46 Similarly, oral or intravenous glutamine can reduce the severity of mucositis, but clinical evidence for its efficacy in preventing infections is lacking. 47,48 Without any specific interventions, mucosal damage starts to heal just before, or with the recovery of granulocytes in peripheral blood (PB), 49 as neutrophil recruitment to the site of mucosal injury may occur up to a week before recovery of neutrophils in PB.…”

Italian consensus conference for the outpatient autologous stem cell transplantation management in multiple myeloma

“…63 Other studies, however, found a positive impact of palifermin on infection rate after BEAM-like conditionings or after TBI. [64][65][66] Furthermore, some studies suggested that, though palifermin was not effective in reducing overall infection rate (mostly central venous catheter related), its use may reduce 'severe' infections such as those due to Gramnegative pathogens or accompanied by focal pneumonia. 66,67 In many centers, G-CSF administration is not routinely performed when the source of hematopoietic cells is mobilized peripheral blood, and the dose of CD34+ cells infused is largely above the threshold required for a proper engraftment.…”