Topics:

Amifostine Shortens Bone Marrow Recovery Period in Breast Cancer Patients

Amifostine Shortens Bone Marrow Recovery Period in Breast Cancer Patients

A study published in the June 1, 1994 issue of the journal Blood demonstrates that amifostine (Ethyol), a selective cytoprotective agent, significantly shortens the time to bone marrow recovery in breast cancer patients undergoing high-dose chemotherapy with autologous bone marrow support. The study also found that amifostine reduces the risk of blood-related complications and supportive care requirements in these patients without reducing the chemotherapy's effectiveness against tumors.

"We were impressed with amifostine's unique ability to selectively protect a broad range of normal tissue including bone marrow, but not tumors, from damage," says Elizabeth J. Shpall, MD, associate director, University of Colorado Bone Marrow Transplant Program, and lead author of the study. "This study demonstrates that amifostine protection significantly shortens the time to bone marrow recovery."

High-dose chemotherapy with autologous bone marrow support, or ABMS, is often effective in treating patients with high-risk breast cancer. Purging the marrow with chemotherapeutic drugs such as 4-hydroperoxycyclophosphamide (4-HC) effectively kills tumor cells, but also is toxic to normal marrow and can delay the ability of the healthy marrow to form new blood cells. This increases the risk of complications such as fever and infection due to low white blood cell count, and can increase the cost of supportive therapy (such as blood transfusions and antibiotic treatment).

The University of Colorado Bone Marrow Transplant Program study was designed to determine if amifostine administered prior to bone marrow purging could reduce the toxicity to normal marrows cells without reducing the effectiveness of 4-HC against tumor cells.

Bone marrow was removed from 15 breast cancer patients, who were assigned to treatment with amifostine and 4-HC, or treatment with 4-HC alone, followed by high-dose chemotherapy with cyclophosphamide, cis-platin and carmustine.

The researchers found that marrow that was treated with amifostine prior to purging with 4-HC resulted in a 200-fold higher recovery of cells that produce white blood cells compared with marrow treated with 4-HC alone, with no reduction in the antitumor effect. The researchers also report:

Marrow engraftment was achieved in an average of 26 days with amifostine treatment compared with an average of 36 days for patients whose marrow was treated with 4-HC alone.

The average number of blood platelet transfusions was significantly less for patients with amifostine-treated marrow compared with those purged with 4-HC alone (12 transfusions vs 29 transfusions).

Patients whose marrow was pretreated with amifostine received fewer days of antibiotic therapy than patients whose marrow was treated with 4-HC alone (28 days vs 40 days).

Three patients whose marrow was purged with 4-HC along required infusions of untreated reserve marrow to recover, while none of the patients whose marrow was exposed to amifostine needed such treatment.

"The results of this study offer significant implications in terms of reducing blood-related complications and toxicities associated with bone marrow support and opening the door for more effective therapies," adds Dr. Shpall. "Additionally, since supportive care needs for patients with infections and bleeding are major contributors to the cost of bone marrow therapy, this study suggests a strong likelihood that amifostine can reduce the expense of treatment for patients who receive 4-HC-purged autologous bone marrow support."

The research was conducted by the University of Colorado Bone Marrow Transplant Program with grant support from U.S. Bioscience, maker of amifostine.

 
Loading comments...

By clicking Accept, you agree to become a member of the UBM Medica Community.