Final analysis of the phase II, randomized, double-blind, placebo-controlled trial of single dose velafermin (CG53135–05) for the prevention of oral mucositis

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6537-6537 ◽  
Author(s):  
M. W. Schuster ◽  
E. Anaissie ◽  
D. Hurd ◽  
W. Bensinger ◽  
J. Mason ◽  
...  
Keyword(s):  
Stem Cell ◽  
Single Dose ◽  
Phase Ii ◽  
Oral Mucositis ◽  
Conditioning Regimen ◽  
Study Drug ◽  
High Dose ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Grade 3

6537 Background: Oral mucositis (OM) is a commonly occurring side effect of high-dose chemotherapy (HDCT) in patients (pts) undergoing autologous hematopoietic stem cell transplant (AHSCT). Velafermin, recombinant human fibroblast growth factor 20, is being investigated for prevention of OM. Velafermin promotes epithelial and mesenchymal cell proliferation in vitro and in vivo. Methods: A phase II trial was conducted to evaluate safety, efficacy, and pharmacokinetics (PK) of velafermin. Inclusion criteria: pts undergoing HDCT and AHSCT with or without total body irradiation (TBI) were enrolled. Velafermin at 0.03, 0.1, or 0.2 mg/kg or placebo was administered as single dose IV at 24h after stem cell infusion. Safety and PK were assessed. Pts were scored daily for presence of OM using the WHO grading scale. The primary endpoint was the incidence of Grade 3/4 OM. Results: A total of 212 pts were randomized to either placebo (n=51) or velafermin at 0.03 (n=50), 0.1 (n=56), or 0.2 (n=55) mg/kg (intent-to-treat or ITT sample). 206 pts (97%) received study drug or placebo. Pt diagnoses included multiple myeloma (57%), non-Hodgkin’s (25%), or Hodgkin’s (11%) lymphoma and 13 pts (6%) received TBI as part of the conditioning regimen. The Grade 3/4 OM incidence rates (%) in the placebo or velafermin arms (0.03, 0.1, and 0.2 mg/kg) were 37, 18, 38, and 36, respectively. The primary analysis of dose dependent reduction of severe OM was not statistically significant (p = 0.549). However, velafermin at 0.03 mg/kg did reduce the incidence of Grade 3/4 OM when compared to placebo alone (p = 0.031). Duration of Grade 3/4 OM was reduced significantly in the 0.03 mg/kg when every pt was evaluated or in the 0.1 mg/kg dose when only pts with Grade 3/4 OM were included in the analysis (p = 0.037 and 0.014, respectively). A total of 5 related SAEs (3 in 0.1 mg/kg, 1 in 0.03 mg/kg, and 1 in placebo cohort) occurred within 4hr of study drug infusion. All symptoms were transient. Conclusion: Single dose velafermin at 0.03mg/kg is may be active in reducing CT induced severe OM in AHSCT pts. Safety profile supports continuing study to define the optimal dose for prevention of severe OM. A new Phase II study will be conducted to confirm velafermin activity at 0.03mg/kg dose. [Table: see text]

scholarly journals Phase II Study of Propylene Glycol-Free Melphalan (Evomela) Combined with Carmustine, Etoposide, and Cytarabine (BEAM) for Myeloablative Conditioning in Lymphoma Patients Undergoing Autologous Stem Cell Transplantation

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3196-3196
Author(s):  
Amanda F. Cashen ◽  
Kendall Gosch ◽  
Theresa Fletcher ◽  
Connie Ceriotti ◽  
Armin Ghobadi ◽  
...  
Keyword(s):  
Stem Cell ◽  
Propylene Glycol ◽  
Phase Ii ◽  
Progressive Disease ◽  
Phase Ii Study ◽  
Conditioning Regimen ◽  
High Dose ◽  
Cell Transplant ◽  
Lyophilized Formulation ◽  
Grade 3

Abstract Introduction: The BEAM conditioning regimen (carmustine [BCNU], etoposide, cytarabine, melphalan) is widely used as the high dose chemotherapy given to patients with non-Hodgkin (NHL) or Hodgkin lymphoma (HL) who are undergoing autologous stem cell transplant (ASCT). The lyophilized formulation of melphalan (Alkeran) commonly included in the BEAM regimen has several limitation based on its marginal solubility and the requirement to reconstitute it in propylene glycol (PG), which itself is associated with toxicities. PG-free melphalan (Evomela) overcomes these limitations by using the solubilizing agent Captisol, an inactive excipient used in 6 FDA-approved parenteral drug formulations, to improve the stability of the reconstituted melphalan. PG-free melphalan is stable for 8-10 hours after reconstitution, it can be refrigerated (unlike Alkeran), and it avoids the potential toxicities of PG. PG-free melphalan has demonstrated bioequivalence to Alkeran, and it was safe and effective when used as the conditioning regimen for multiple myeloma patients undergoing ASCT. This Phase II study investigated the safety and efficacy of high-dose PG-free melphalan when included in the BEAM regimen. Methods: Adult patients with NHL or HL who were eligible for ASCT and gave informed consent were prospectively enrolled after collection of an adequate peripheral blood stem cell product. Carmustine, etoposide, and cytarabine were given at standard doses on Day -6 thru Day -3. PG-free melphalan, 140 mg/m2, was diluted with normal saline to a concentration of ≤ 0.45 mg/ml and infused over 30 minutes on Day -2. Autologous stem cells were infused on Day 0. Supportive care was per institutional standards. The primary endpoint was toxicity, and patients were followed post-transplant for toxicity, engraftment, and disease response. Results: Forty-five patients were enrolled from April 2014 thru June 2015 (mean age 52, range 18-73; 31 males/14 females; 32 NHL [15 diffuse large B-cell, 8 mantle cell, 9 other]/13 HL). Response prior to transplant was complete remission (CR, n=21), partial remission (PR, n=22), or progressive disease (PD, n=2). All patients completed BEAM with PG-free melphalan and stem cell infusion (median 5.1 CD34+ cells/kg), and 40 patients had sufficient follow-up for toxicity and engraftment assessments. The most common Grade 3-4 non-hematologic toxicities were neutropenic fever, (n= 26, 67%), infections (n=16, 41%), and electrolyte abnormalities (hypokalemia and hypophosphatemia in 8 and 23 patients, respectively). Twenty-four patients (60%) had oral mucositis, which was mostly Grade 2 (21 with Grade 2; 3 with Grade 3). Moderate or severe gastrointestinal toxicities were uncommon; 5 patients (12.5%) had Grade 3 diarrhea and 3 (7.5%) had Grade 3 nausea/vomiting. There were no treatment-related deaths. Thirty-nine patients (98%) had neutrophil and platelet engraftment at mean 10 and 21 days, respectively. One patient did not have platelet engraftment by Day +100. Among 36 patients who had response assessment at 60-100 days post-ASCT, 29 (81%) were in CR, 2 in PR, and 6 had PD. There have been three deaths, at 6-12 months post ASCT, all due to progressive disease. Conclusions: PG-free melphalan can be used in place of the standard, lyophilized formulation of melphalan in the BEAM regimen for lymphoma patients undergoing ASCT. It was shown to have a safety profile that compares favorably with Alkeran, and it avoids potential PG-associated toxicities. Of note, Grade 3-4 mucositis, diarrhea, and nausea/vomiting each occurred in fewer than 15% of patients, the engraftment rate was high (98%), and response rates were consistent with expectations. Disclosures No relevant conflicts of interest to declare.

Phase I Trial of CG53135-05 to Prevent Mucositis in Patients Undergoing High-Dose Chemotherapy (HDCT) and Autologous Peripheral Blood Stem Cell Transplantation (PBSCT).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1161-1161
Author(s):  
Michael W. Schuster ◽  
Tsiporah B. Shore ◽  
June Greenberg ◽  
Bita Jalilizeinali ◽  
Scott Possley ◽  
...  
Keyword(s):  
Stem Cell ◽  
Phase I ◽  
Oral Mucositis ◽  
Phase I Trial ◽  
Study Drug ◽  
Great Promise ◽  
Cell Transplant ◽  
Conditioning Regimens ◽  
Grade 3 ◽  
Experienced Grade

Abstract Mucositis is a painful side effect of many transplant conditioning regimens used in HDC and PBSCT. This complication often requires treatment with potent narcotic analgesics and may even require intravenous patient-controlled analgesia (PCA) for adequate pain relief as well as total parenteral nutrition (TPN). Infections in this setting may also result from disruption of the mucosal barrier with subsequent migration of intestinal bacteria into the blood stream. Previous treatments with oral rinses and topical applications of soothing gels have largely been ineffective. Recently, a breakthrough class of drugs in the fibroblast growth factor (FGF) family holds great promise in more effectively ameliorating or even preventing oral mucositis (OM). We report on the results of a Phase I trial with CG53135-05, a novel investigational protein therapeutic (FGF-20) that promotes epithelial and mesenchymal cell proliferation in vitro and has demonstrated activity in animal models. 14 patients (ages 25–75) undergoing HDCT with PBSCT were treated with escalating doses of study drug, including 0.1 mg/kg, 0.2 mg/kg and 0.33 mg/kg (concentrations are determined by the UV method which are equivalent to 0.3, 0.6, and 1 mg/kg by the Bradford method previously used). Conditioning regimens used included melphalan (Mel 200), cyclophosphamide, carmustine and etoposide (CBV), carboplatin and thiotepa (CT), cyclophosphamide, etoposide and carmustine (CEC) and busulfan/cyclophosphamide (targeted BuCy). The primary objective of this phase I trial was to evaluate safety, tolerability and pharmacokinetics of CG53135-05. Patients (pts.) were also scored daily for presence of OM using both the WHO and OMAS (oral mucositis assessment scale) grading scales. 7/14 pts. in this study experienced no OM (including 2 Mel 200 patients), 5 pts. experienced only grade 1 OM. while 2 pts. (both treated with Mel 200) experienced grade 3 OM, and no pts. experienced grade 4 OM. 1 pt. experiencing grade 3 OM required TPN. Only 4 pts. experienced diarrhea that lasted more than 4 days and only 1 pt. had gut mucositis-associated (E. coli) bacteremia. The median day of engraftment (ANC>500/uL) occurred on day 14 (range: day 11–19). Patients tolerated the study drug well with no significant side effects up to a dose of 0.33 mg/kg. At that dose, 2 pts. experienced an infusional reaction consisting of fevers, nausea, and mild hypotension. Pharmacokinetics were measured at all dose levels and will be presented. CG53135-05 is a member of a breakthtrough drug class (FGF family) that was well tolerated in autologous stem cell transplant patients at doses up to 0.33 mg/kg with apparent clinical effects in ameliorating or preventing OM - 12/14 pts, thus, avoided severe (grades 3–4) mucositis following HDCT. A larger Phase II clinical trial is planned.

Icing oral mucositis: Oral cryotherapy in multiple myeloma patients undergoing autologous hematopoietic stem cell transplant

2016 ◽  
Vol 23 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Joey Chen ◽  
Jamie Seabrook ◽  
Adrienne Fulford ◽  
Irina Rajakumar
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Oral Mucositis ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
High Dose ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Oral Cryotherapy ◽  
High Dose Melphalan

Background Up to 70% of patients receiving hematopoietic stem cell transplant develop oral mucositis as a side effect of high-dose melphalan conditioning chemotherapy. Oral cryotherapy has been documented to be potentially effective in reducing oral mucositis. The aim of this study was to examine the effectiveness of the cryotherapy protocol implemented within the hematopoietic stem cell transplant program. Methods A retrospective chart review was conducted of adult multiple myeloma patients who received high-dose melphalan conditioning therapy for autologous hematopoietic stem cell transplant. Primary endpoints were incidence and severity of oral mucositis. Secondary endpoints included duration of oral mucositis, duration of hospital stay, parenteral narcotics use and total parenteral nutrition use. Results One hundred and forty patients were included in the study, 70 patients in both no cryotherapy and cryotherapy groups. Both oral mucositis incidence and severity were found to be significantly lower in the cryotherapy group. Fifty (71.4%) experienced mucositis post cryotherapy compared to 67 (95.7%) in the no cryotherapy group (p < 0.001). The median oral mucositis severity, assessed using the WHO oral toxicity scale from grade 0–4, experienced in the no group was 2.5 vs. 2 in the cryotherapy group (p = 0.03). Oral mucositis duration and use of parenteral narcotics were also significantly reduced. Duration of hospital stay and use of parenteral nutrition were similar between the two groups. Conclusion The cryotherapy protocol resulted in a significantly lower incidence and severity of oral mucositis. These results provide evidence for the continued use of oral cryotherapy, an inexpensive and generally well-tolerated practice.

A Randomized Placebo Controlled Phase II Trial of Prevention of Severe Oral Mucositis Using Single Dose Velafermin in Patients Receiving Myeloablative Therapy and Autologous Hematopoietic Stem Cell Transplant (AHSCT).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 615-615 ◽  
Author(s):  
Michael W. Schuster ◽  
J. Mehta ◽  
E.K. Waller ◽  
R.M. Rifkin ◽  
I. Micallef ◽  
...  
Keyword(s):  
Stem Cell ◽  
Adverse Events ◽  
Oral Mucositis ◽  
Interim Analysis ◽  
Safety Information ◽  
Study Drug ◽  
Controlled Study ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Safety And Efficacy

Abstract Oral mucositis (OM) is a commonly occurring side effect in patients (pts) undergoing AHSCT. Velafermin, recombinant human fibroblast growth factor-20, is under investigation for the prevention of severe OM. Previous studies demonstrated that velafermin at 30 mcg/kg was well tolerated and was effective in reducing the incidence of severe mucositis. The primary objective of this multicenter, randomized, double-blind, placebo controlled study was to confirm safety and efficacy of 30 mcg/kg velafermin for prevention of severe OM incidence (grade 3/4 OM based on the WHO grading system). The secondary objective was to evaluate safety and efficacy of 10 and 60 mcg/kg doses to better define the therapeutic range. Pts were randomized to receive placebo or velafermin at 30, 10 or 60 mcg/kg in a 3:3:1:1 ratio 24–36 hrs after stem cell infusion. Randomization was stratified by study center and OM risk factors identified from the previous placebo controlled study in a similar population including conditioning regimen and body mass index (BMI ≥30). Pts with multiple myeloma or lymphoma (≥18 y.o.) receiving ≥2X106 /kg CD34+ cells following chemotherapy with or without Total Body Irradiation (TBI) were eligible. OM status and safety data were collected for 30 days post treatment while mortality and disease progression were followed for 1 yr. An interim analysis by a data monitoring committee (DMC) was planned to assess safety and efficacy after 50% of pts completed the 30 day treatment period. A total of 390 pts who received melphalan (200 mg/m2) (n=239), BEAM (n=129), TBI (n=15), or other (n=7) were randomized and 384 pts were treated. The study drug was well tolerated in general and no pts discontinued study due to drug-related adverse events. There were 93 serious adverse events (SAEs) in 78 (20%) pts and no drug-related death was reported. Five infusion-related SAEs were reported including vasovagal episode (2), syncope (2), and anaphylactoid reaction (1). All 5 episodes occurred on the day of study drug infusion and resolved on the same day with no sequelae. Based on review of the results from the interim analysis, which included safety and efficacy data from 200 pts, the DMC recommended that the study continue to completion as planned. The last pt has completed the 30 day study period. The un-blinded results of the OM efficacy endpoints from velafermin treated groups or placebo as well as 30-day safety information from all pts will be reported.

Successful Peripheral Haematopoitic Autologous Stem Cells Transplants After More Than 5 Days of without Cryopreservation In Non Hodgkin Lymphoma: Asian Scenario

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4447-4447
Author(s):  
Sandeep Jasuja ◽  
Hemant Malhota ◽  
Neetu Kukar(Jasuja) ◽  
Dinesh Gautam ◽  
Shrikant Sharma ◽  
...  
Keyword(s):  
Stem Cells ◽  
Developing Countries ◽  
Stem Cell ◽  
Median Time ◽  
Eligible Patient ◽  
Conditioning Regimen ◽  
High Dose ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Post Transplant

Abstract Abstract 4447 Background: Methods to simplify the stem cell transplantation procedure are the need of the hour in developing countries due to constraints of affordability and the large number of eligible patient for transplantation. Unprocessed leukapheresed material is useful to restore hemopoiesis after high dose chemotherapy and, in addition to being significantly less expensive, it also avoids the toxicity of cryopreservation (DMSO). Method: Over a period of 18 months (January 2009 to June 2010) in a hospital setting, we prospectively performed auto transplants in 5 relapsed/resistant non-Hodgkin's lymphoma patients using non-cryopreserved (stored for 5–8 days at 4°C) and un-manipulated peripheral blood stem cells mobilized by GCSF (10mg/kg/day) and GMCSF (5mg/kg/day) using a 5–7 day conditioning regimen. Viability of stem cells was checked daily by trypen blue and the cell were reinfused cells when viability comes down to less then 80% (minimum 5 days) or on day 8 which ever was earlier. The median collection of CD34+ stem cells was 2.8 × 106/cu mm (range 2–4.8 × 10 6/cumm) Result: The median time to achieve > 0.5 × 109/l granulocytes was 14 days. The median time to achieve > 20 × 109/l platelets was 16 days. CR was achieved in 4 cases. A very good partial response was achieved in 1 case. The 100-day mortality was zero. One patient, who was not in CR, died from relapse of the lymphoma, 9 months post transplant. The overall median post-transplant survival for other patients has not been reached. The approximate cost of the each graft was US$6,000. Conclusion: From this small series, we conclude that a simplified method to autograft patients avoiding purging procedures and cryopreservation of the cells is feasible. This technique helps avoid toxicity of DMSO and significantly decreases the cost of autologous hematopoietic stem cell transplant, perhaps in the world, an important issue in developing countries. Disclosures: No relevant conflicts of interest to declare.

Prevention of Oral Mucositis with Palifermin in Patients Treated with High-Dose Chemotherapy and Autologous Stem Cell Transplantation. A Single Center Experience.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2974-2974
Author(s):  
Francois Luthi ◽  
Lorenzo Berwert ◽  
Valérie Frossard ◽  
Oscar Marchetti ◽  
Anne Rosselet ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Oral Mucositis ◽  
Conditioning Regimen ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Group A ◽  
Grade 3 ◽  
Group B

Abstract It was demonstrated in a placebo controlled randomized study that Palifemin decrease the severity of oral mucositis in patients (pts) treated with total body irradiation (TBI), high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT). The benefit of this treatment in pts who are not receiving TBI-containing conditioning regimen is still unclear. We evaluated prospectively the effect of Palifermin on mucositis prevention in 34 consecutive pts treated with HDCT and ASCT compared to an historical group of pts who did not receive Palifermin. Between 03/2005 and 05/2006, 34 pts (Group A) treated with Melphalan 200 (n=15) or BEAM (n=19) gave informed consent and received 6 injections of 0.06 mg/kg of Palifermin (3 days (d.) before HDCT and 3 d. following ASCT). Four were excluded from efficacy analysis, 2 of them due to Melphalan dose reduction and 2 due to early discontinuation of Palifermin. They were compared to 77 pts (Group B) treated with Melphalan 200 (n=43) or BEAM (n=34) from 2003 to 2005. WHO grading was used for toxicity assessment. The median age was 55 years in group A (Range 28–67) and 54 years in group B (Range 19–66). The median count of CD34 cells/kg infused was 4.2 millions (Range 1.96–23.9) in group A and 3.85 millions (Range 1.8–16.2) in group B. The median time for engraftment was the same in both groups and was respectively 11 d. for neutrophils (Range 8–12) and 11 d. for platelets (Range 8–13) in group A, 11 d. for neutrophils (Range 8–13) and 11 d. for platelets (Range 8–18) in group B. Severe oral mucositis (Grade 3 and 4) was lower in group A (17%) than in group B (44%). The incidence of grade 2 or more digestive mucositis was similar in the 2 groups (66% vs.60%) as well as the total opioid use (43% vs 57%). All patients but one in the group B developed fever. Fever of unknown origin were more frequent in group A due to less fever attributed to grade 3 or 4 mucositis.In group A, all but 3 pts developed toxicities. Grade 3 or 4 toxicities consisted in erythematous rash in 15 pts (44%), generalized oedema in 2 and odynophagia in 1. Grade 1 or 2 toxicities were pruritis (24%), rash (32%), localized oedema (26%) and buccal discomfort (41%). 1 pt died at d.12 from an hemophagocytic syndroma and onother at d.90 from a rapidly progressive colorectal cancer. We conclude that the use of Palifermin reduced the incidence of grade 3 or 4 mucositis in our group of pts treated without TBI, but did not decrease either digestive mucositis or the use of morphinic. The benefit of Palifermin on mucositis prevention has still to be balanced again the risk of discomfort and toxicities of this drug. Large randomized studies are still needed before recommending the systematic administration of Palifermin to pts receiving Melphalan 200 or BEAM as conditioning regimen before ASCT.

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