Non-Steroid Anti-Inflammatory Drug Salsalate Provides Safe and Effective Pain Control during Stem Cell Transplantation

Abstract

<h3>Intro</h3> NSAIDs are drugs of choice for the treatment musculo-skeletal pain and other inflammatory conditions. Salsalate is a platelet sparing NSAID with less gastric toxicity compared to aspirin. Using NSAIDs during HSCT is challenging as periods of profound pancytopenia and toxicity raise concerns about the safety of these agents. To date, the use of salsalate during HSCT has not been previously reported. <h3>Methods</h3> All HSCT recipients treated with salsalate for at least 7 days during the period of profound neutropenia and thrombocytopenia were included. Patients were monitored for kidney, liver (25% for > 2 days), hearing, emergence of GI/GU or other bleeding disorders, time to engraftment, drug toxicity or discontinuation. The Verbal Rating Scale for Pain (Severe: 7-10, Moderate: 4-6, Mild: 1-3) was used to grade pain before and after treatment. <h3>Results</h3> 44 (28 autologous and 16 allogeneic) stem cell recipients were identified. Female (24/44; 55%), Age -61(32-74); Dx: Myeloma (n=24), NHL (n=8), AML (n=5), Other(n=7). 8 patients were receiving NSAIDS prior to admission. 6 patients were admitted with baseline grade 3 CKD . Median WBC and platelet nadir while receiving salsalate was <0.1 and 8 cells/ml respectively. Median salsalate start date was Day+4(-6-32), median daily dose was 1.5g/day (1-3gm), and number of treatment days was 9(7-41). More than 80% patients experienced mucositis in addition to their treatment-directed pain. Table 1 show pain was improved or eradicated in 27/44 (64%) of patients, and stable in 15/44 (36%)- 9 of which were receiving NSAID PTA. All patients who experienced generalized body pain improved with salsalate. Change in kidney and liver function was infrequent (<10%) and there were no major bleeding episodes or hearing loss. Discontinuation occurred in 4 patients, 2 in patient for possible toxicity, and 2 for lack of effect. Time to engraftment was within normal limits and there was no hospital related mortality. Moderate doses of NSAID salsalate are well tolerated throughout the entire transplantation period in autologous and allogeneic recipients and may benefit patients with a variety of different types of pain, including growth factor, engraftment and cytokine release pain syndromes. Additional studies are needed to confirm these results.