Palifermin for Prevention of Oral Mucositis in Hematological Malignancies: Present Position and Future Perspectives

Background: Oral Mucositis (OM) is an inevitable side effect of cytotoxic chemotherapy and?or radiotherapy used for haematopoietic stem cell transplantation (HSCT) in hematologic malignancies. Paliferminis the only available effective preventive strategy for management of OM in the setting of HSCT but is frequently overlooked in the treatment algorithms. Aims: The objectives of our study were to 1) review the present evidence for the use of palifermin in prevention of gastrointestinal mucositis. 2) Explore the implications of palifermin use on the management of hematological malignancies, particularly in the setting of autologous transplants. Methods: A comprehensive systematic review of the literature was performed. There were no language restrictions and the following medical subject heading terms were used: “melphalan,” “multiple,” “myeloma,” “oral,” “mucositis,” “doseescalation,” “autologous,” “stem?cell transplantation”. The quality of studies, whether randomized controlled trials (RCTs) or retrospective studies was measured using Jadad or new?castle Ottawa scale respectively. Results: A total of 10 out of 24 studies met the inclusion criteria. These were2 randomized controlled?trials, 3 case?series, and 5 prospective studies. In 4 out of 10 studies included, no specific data was available regarding the outcome of palifermin use in OM in multiple myeloma (MM) patients following ASCT. Majority of the studies had insufficient power and?or lacked sufficient sample size but palifermin use was found toper form reasonably well in preventing OM in MM patients. In 3 RCTs, palifermin was noted to enable safe administration of higher doses of melphalan. Conclusion: Palifermin is an effective cytoprotective agent that aids in prevention of OM in MM patients.