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Annals of Oncology Advance Access originally published online on May 2, 2008
Annals of Oncology 2008 19(9):1644-1649; doi:10.1093/annonc/mdn179
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

palliative care/quality of life

Use of palifermin for the prevention of high-dose methotrexate-induced oral mucositis

E. Schmidt, N. H. Thoennissen, A. Rudat, R. Bieker, C. Schliemann, R. M. Mesters, M. Zühlsdorf, C. Müller-Tidow and W. E. Berdel*

Department of Medicine, Hematology and Oncology, University Hospital Muenster, Muenster, Germany

* Correspondence to: Dr W. E. Berdel, Universitätsklinikum Muenster, Medizinische Klinik, Albert-Schweitzer-Strasse 33, D-48149 Muenster, Germany. Tel: +49-251-8347587; Fax: +49-251-8347588; E-mail: berdel{at}uni-muenster.de

Background: Oral mucositis is a frequent problem after high-dose methotrexate (HD-MTX), impairing patient's quality of life, leading to higher rates of infections and delaying subsequent chemotherapy. This report describes the effect of palifermin in patients treated within the GMALL-B-ALL 2002 protocol containing HD-MTX who developed a severe mucositis in cycle A1/B1.

Patients and methods: Ten patients, all with World Health Organization grades III–IV oral mucositis in cycles A1/B1, obtained palifermin with subsequent similar or identical cycles to reduce mucositis. Thus, patients serve as their own control for efficacy of palifermin.

Results: All 10 patients developed grades III–IV mucositis in cycles A1/B1 without palifermin, whereas only two of 10 developed grades III–IV mucositis in corresponding cycles A2/B2 with palifermin. Only four of 10 patients showed infections in the cycles with palifermin compared with 10 of 10 patients without palifermin. The duration of mucositits in patients who acquired a higher grade mucositis despite treatment with palifermin could be reduced from 12.9 days (median) without to 11 days with palifermin. The amount of i.v. opioid analgetics could be significantly reduced.

Conclusion: Palifermin might reduce the incidence, severeness and duration of oral mucositis in HD-MTX-based chemotherapy and may influence clinical sequelae such as infection and quality of life.

Key words: methotrexate, oral mucositis, palifermin

Received for publication November 28, 2007. Revision received March 26, 2008. Accepted for publication March 31, 2008.


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