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Autografting

Gut protection by palifermin during autologous haematopoietic SCT

Bone Marrow Transplantation volume 43, pages 807–811 (2009)Cite this article

Abstract

Conditioning therapy in connection with haematopoietic SCT (HSCT) induces a disruption of the intestinal barrier function facilitating the permeation of bacteria and endotoxin through the bowel wall with subsequent increased risk of septicaemia and a worsening of GVHD in the allogeneic setting. Palifermin (recombinant human keratinocyte growth factor) reduces the severity of oral mucositis with HSCT. The present trial investigates its effect on intestinal barrier function. Seventeen lymphoma patients undergoing autologous HSCT received palifermin. Intestinal permeability was assessed before the conditioning therapy and on days +4 and +14. Clinical oral and gastrointestinal toxicity was prospectively assessed in parallel. A comparison was made with matched historical study patients (n=21). Patients treated with palifermin had a significantly better preserved intestinal barrier function (P=0.01 on day +4) and were in less need of total parenteral nutrition (P=0.005) as compared with controls. No significant reduction of clinical gastrointestinal or oral toxicity was observed. The intestinal barrier function, normally disrupted by the conditioning therapy, is preserved by palifermin. Whether intestinal barrier preservation protects from invasive infections, and in the allogeneic setting diminishes GVHD severity, remains to be investigated in randomized controlled trials.

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Acknowledgements

We thank all the patients for their participation in the trial. The study was supported by an unrestricted grant from Amgen. The company did not have any influence on the planning or conduct of the study and was not involved in the writing of the manuscript.

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Authors and Affiliations

  1. Department of Haematology, Sahlgrenska University Hospital, Göteborg, Sweden

    J-E Johansson & D Stockelberg

  2. Department of Oral Immunology, Institute of Odontology, Clinic of Oral Medicine, Public Dental Health, Västra Götalandsregionen, Göteborg, Sweden

    B Hasséus, P Johansson, C Eklöf & D Öhman

  3. Department of Oral Immunology, Institute of Odontology, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden

    B Hasséus

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  1. J-E Johansson
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  2. B Hasséus
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  3. P Johansson
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  4. C Eklöf
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  5. D Öhman
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  6. D Stockelberg
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Correspondence to J-E Johansson.

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Johansson, JE., Hasséus, B., Johansson, P. et al. Gut protection by palifermin during autologous haematopoietic SCT. Bone Marrow Transplant 43, 807–811 (2009). https://doi.org/10.1038/bmt.2008.388

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