A randomized trial of prophylactic palifermin on gastrointestinal toxicity after intensive induction therapy for acute myeloid leukaemia

作者：Bradstock Kenneth F^*; Link Emma; Collins Marnie; Di Iulio Juliana; Lewis Ian D; Schwarer Anthony; Enno Arno; Marlton Paula; Hahn Uwe; Szer Jeff; Cull Gavin; Seymour John F

来源：British Journal of Haematology, 2014, 167(5): 618-625.

DOI：10.1111/bjh.13086

• palifermin
• keratinocyte growth factor
• acute myeloid leukaemia
• mucositis
• chemotherapy

Gastrointestinal toxicity, including oral mucositis, is a frequent complication of intensive combination chemotherapy for acute myeloid leukaemia (AML) and contributes substantially to treatment-related mortality. We conducted a placebo-controlled randomized trial to evaluate the efficacy of palifermin (keratinocyte growth factor), given at 60 lg/kg per daily IV for 3 d before and after chemotherapy, for mucosal protection in adult patients with previously untreated AML receiving induction therapy with idarubicin, high-dose cytarabine and etoposide. Among 155 randomized patients, there was no statistically significant difference in the rate of grade 3 and 4 oral mucositis (primary study endpoint) between the two treatment arms (three in palifermin arm (4%), 8 in placebo arm (10%; P = 0.21); however, when considering the severity of oral mucositis (World Health Organization grade 0-4), there was evidence of reduced rates of higher grades of oral mucositis in the palifermin arm (P = 0.0007, test for trend). There was a statistically significantly lower rate of grades 3 and 4 gastrointestinal adverse events in the palifermin arm (21% vs. 44% in placebo arm; P = 0.003), mainly due to a reduction in severe diarrhoea (8% palifermin, 26% placebo; P = 0.01). Palifermin has activity as a mucosal protectant in AML patients receiving intensive chemotherapy. This trial is registered at ACTRN012605000095662.

• 出版日期2014-12