Combined Amifostine And Cryotherapy For Prevention Of Oral Mucositis (OM) Following High Dose Chemotherapy With Melphalan And Autologous Hematopoietic Cell Transplant (HCT) For Multiple Myeloma (MM)

Abstract

OM is a major cause of morbidity following autologous HCT for MM. Amifostine is a free radical scavenger that reduces proinflammatory cytokine production. Cryotherapy causes vasoconstriction of vessels in the oral cavity. Randomized controlled trials have demonstrated a significant reduction in the severity and duration of OM when amifostine or cryotherapy is administered with high dose melphalan prior autologous HCT for MM. To date, no report has been made of outcomes when both treatments are used concurrently. We performed 28 autologous HCTs on 21 patients with MM in an outpatient setting. Patients received amifostine 740 mg/m2 24 hours prior to and immediately prior to melphalan (200 mg/m2 for 19 patients and 140 mg/m2 for 2 patients; dose dependent on renal function). Cryotherapy was administered for four hours beginning 30 minutes prior to the administration of melphalan. Six patients had a decline in systolic blood pressure of≥20% of baseline following the administration of amifostine. Aggressive intravenous hydration and Trendeleberg positioning resulted in the rapid return to baseline blood pressure in all cases. Prehydration and holding antihypertensive medications for 24 hours prior to the first dose of amifostine reduced symptomatic hypotension. No patient was admitted for OM. The one patient who required both total parenteral nutrition and narcotic analgesics for grade III OM did not remove his dentures during cryotherapy. One patient experienced grade II OM that was managed with oral narcotic analgesics. The remaining 19 patients experiencing either grade I (n=1) or no (n=18) OM. Combined amifostine and cryotherapy is a well-tolerated and effective method of reducing OM following high dose melphalan and autologous HCT for MM.