Pentoxifylline, ciprofloxacin and prednisone failed to prevent transplant-related toxicities in bone marrow transplant recipients and were associated with an increased incidence of infectious complications

Abstract

Summary:Intensive therapy followed by hematopoietic progenitor TNF-␣ (Tumor necrosis factor-alpha) is involved in administration has improved the prognosis of many dismany immunological and inflammatory processes, and eases in the last 30 years. However, this procedure is commight be expected to play an important role in the plicated by secondary events which may endanger the development of BMT-related complications. Triple therpatient's life in 23-35% of cases. 1 Conditioning-related apy (pentoxifylline, ciprofloxacin and prednisone) with toxicity, graft rejection, graft-versus-host disease and postknown anti-TNF activity was tested in 37 patients undergoing a hematopoietic progenitor transplant transplant immunodeficient status are the most frequent (HPT). A control group of 16 patients with similar complications after hematopoietic progenitor transplancharacteristics was selected among consecutive patients tation (HPT). receiving a HTP in a neighboring center who did not Basal disease, the source of hematopoietic progenitors receive anti-TNF prophylaxis. Major transplant-related and conditioning therapy used also influence patients' outcomplications were registered (VOD, acute GVHD, come. infectious episodes, renal failure and mucositis) and sur-TNF-␣ and other inflammatory cytokines have directly vival status. TNF plasma concentrations were deterbeen involved in tissue damage after HPT. 2 High TNF-␣ mined by ELISA, and pentoxifylline plasma concenlevels have been detected in patients with infectious epitrations were determined by HPLC. Among patients sodes, graft-versus-host disease (GVHD) and hepatic venotreated with pentoxifylline (PTX), ciprofloxacin and occlusive disease (VOD). 3,4 As TNF-␣ is thought to be steroids, no difference in the mean survival time was responsible for the initiation and perpetuation of tissue observed compared with the control group. The incidamage, strategies such as anti-TNF antibody adminisdence of procedure-related death up to day +35 was tration 5 or inhibition of TNF synthesis have been assessed 11% in the study group and 6% in the control group.in order to decrease transplant-related complications. In spite of a tendency to a lower incidence of mucositis Pentoxifylline (PTX) is a xanthine with a strong inhibithere was a higher incidence of infections (positive blood tory effect on TNF synthesis in vitro, 6 which may also procultures) in the study group (49%) than in the control tect experimental animals from renal dysfunction induced group (16.7%) (P = 0.16). This difference achieved statby cyclosporin A or amphotericin B. 7,8 istical significance in patients receiving an allogeneic Bianco et al 9 showed a decreased incidence of VOD, HPT (P = 0.05). It is likely that the use of steroids in the GVHD, mucositis, renal failure and fever in patients early period after transplant increases infectious epiundergoing BMT treated with PTX orally. Later reports sodes and makes control of GVHD difficult. The com-have not proven such a benefit. 10,11 bined administration of steroids w...

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“…213 However, none of the consecutive randomized, placebocontrolled trials found pentoxifylline to be effective. [214][215][216][217][218][219][220] …”

Prophylaxis and treatment of chemo- and radiotherapy-induced oral mucositis – are there new strategies?

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Profiling of pro-inflammatory cytokines in radiation induced oral mucositis (riom) among indian patients

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