A Randomized Phase II Study of Amifostine Used As Stem Cell Protectant in Non-Hodgkin Lymphoma Patients Receiving Cisplatin-Based Salvage Chemotherapy Prior to Stem Cell Transplant

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Abstract
Stem cell mobilization may be inadequate in many lymphoma patients in need for autologous stem cell transplant (SCT). In this study, we sought to evaluate a potential role of amifostine as a stem cell chemoprotective agent in lymphoma patients receiving DHAP chemotherapy in preparation for high-dose chemotherapy (HDC) and stem cell transplant (SCT). In the beginning of the DHAP course, patients were randomized 1:1 to receive amifostine at 740 mg/m2. Stem cells were mobilized with GCSF after the last cycle of DHAP. Stem cell collection started upon ANC recovery over 1000/mm3. Standard 10 lt. apheresis daily with a goal of a minimum of 2 × 106 stem cells/kg were performed. Twenty-one patients have been enrolled; 10 received amifostine pretreatment (age, 20–64) and 11 were randomized to the control arm (age, 18–63). Prior chemotherapy was balanced in the two groups. The median number of DHAP treatments for each group was 2. Amifostine was well tolerated and was associated with higher stem cell collection. Toxicity and time to engraftment were comparable between the two groups. Our preliminary results may suggest a role of amifostine in protecting stem cells during salvage chemotherapy, thus facilitating stem cell collection.