An analysis of protective effect for mucositits by amifostine on total body irradiation during hematopoietic stem cell transplantation

Objective: To evaluate the efficiency of amifostine in protecting against oral and gastrointestinal mucositis in hematologic malignancies patients with high-dose total body irradiation following the hematopoietic stem cell transplantation, and assess the hematologic recovery as well as the potential side effect of amifostine. Methods: Thirty-two hematologic malignancies patients underwent hematopoietic stem cell transplantation in our institution from 2012 to 2016 were retrospectively analyzed. All of them were treated with total body irradiation (700-1200 cGy) and high-dose chemotherapy, in which 14 patients received 400 mg amifostine before radiotherapy. Prior institutional experience in 18 patients treated without amifostine was used as a historical comparison (no-amifostine group). Results: Severe oral mucositis occurred in 14.3% of patients in the amifostine group while 77.2% in the no-amifostine group(χ² = 10.62, P < 0.05). Total parenteral nutrition was used in 21.4% of amifostine group and 38.8% in no-amifostine group (P > 0.05). The rates of grade 2 and 3 gastrointestinal mucositis were 35.7% and 61.5% in amifostine group, while in no-amifostine group the rates were 33.3% and 66.7%, respectively (P > 0.05). No significant difference was found in engraftment times of granulocyte and platelet. No amifostine related side effects were observed. Conclusions: The combination of amifostine and total body irradiation conditioning therapy during hematologic stem cell transplantation might reduce the severity of oral mucositis. The utilize of amifostine has no obvious effect on hematopoietic recovery and can be well tolerated. (authors)