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Palifermin, administered for three doses only, reduces mucositis in patients undergoing HSCT and receiving chemoradiotherapy conditioning

Bone Marrow Transplantation volume 57, pages 1329–1331 (2022)Cite this article

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Oral mucositis, a common complication of chemotherapy and/or radiotherapy, presents with varying severity of erythematous and ulcerative lesions [1, 2]. Myeloablative chemotherapy and radiation-based conditioning with autologous and allogeneic haemopoietic stem cell transplantation (auHSCT, aHSCT) are established treatments for haematological malignancies [3, 4]. In these settings, the incidence of severe oral mucositis, defined as World Health Organization (WHO) grade 3 and 4 (G3/4), is reported at 80–100%, with a significant cost burden to health systems [1, 4,5,6]. It is described as a feared and incapacitating complication for patients, resulting in pain and difficulty eating, often requiring parenteral opioid analgesia (POA) and parenteral nutrition (PN) [1, 3, 4, 7].

Palifermin, a recombinant human keratinocyte growth factor, binds to endogenous receptors, stimulating mucosal thickening and offering protection against assault from chemotherapy and/or radiotherapy [8]. The official product information for palifermin (Kepivance, Amgen) recommends six doses of 60 μg/kg/day, as an intravenous (IV) injection for 3 consecutive days before and 3 consecutive days after chemoradiotherapy [7, 8]. However, the significant cost of palifermin presents a barrier to routine use. Shorter courses of palifermin may provide the clinical benefit of mucosal thickening at a less prohibitive cost for routine use. Based on pre-clinical data and early clinical studies [9,10,11,12,13], a protocol was implemented at the study institution, with palifermin administered for three doses only prior to chemoradiotherapy. This study aimed to evaluate the effectiveness of this novel, modified palifermin dosing in patients undergoing HSCT.

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Fig. 1

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Pharmacy Department, Alfred Health, Commercial Road, Melbourne, VIC, 3004, Australia

    John Coutsouvelis & Michael Dooley

  2. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia

    John Coutsouvelis, Michael Dooley, Carl M. Kirkpatrick & Ria Hopkins

  3. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia

    Michael Dooley

  4. Department of Malignant Haematology and Stem Cell Transplantation, The Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia

    Sharon Avery

  5. Cancer Care Services IMECYS, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, 4870, Australia

    Sharon Avery

  6. National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, 2052, Australia

    Ria Hopkins

  7. Department of Malignant Haematology and Stem Cell Transplantation, Alfred Health – Monash University, Commercial Road, Melbourne, VIC, 3004, Australia

    Andrew Spencer

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  1. John Coutsouvelis
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Contributions

All authors conceived and designed the work that led to the submission, acquired data, played an important role in interpreting the results, drafted and revised the manuscript, approved the final version and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JC was responsible for designing the study protocol, collecting and analysing the data, formulating the discussion, drafting, revising and finalising the manuscript. MD was responsible for designing the study protocol, interpreting the data, drafting, revising and finalising the manuscript. CMK was responsible for designing the study protocol, interpreting the data, drafting, revising and finalising the manuscript. SA was responsible for designing the study protocol, interpreting the data and revising the manuscript. RH was responsible for designing the study protocol, data collection, formatting the tables and figures and revising the manuscript. AS was responsible for designing the study protocol, interpreting the data, revising and finalising the manuscript.

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Correspondence to John Coutsouvelis.

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Coutsouvelis, J., Dooley, M., Kirkpatrick, C.M. et al. Palifermin, administered for three doses only, reduces mucositis in patients undergoing HSCT and receiving chemoradiotherapy conditioning. Bone Marrow Transplant 57, 1329–1331 (2022). https://doi.org/10.1038/s41409-022-01714-6

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  • DOI: https://doi.org/10.1038/s41409-022-01714-6

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