Gut protection by palifermin during autologous haematopoietic SCT
Gut protection by palifermin during autologous haematopoietic SCT
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DOI：
10.1038/bmt.2008.388
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发表时间：
2009-05-01
影响因子：
4.8
通讯作者：
Stockelberg, D.
中科院分区：
文献类型：
--
作者：
Johansson, J-E;Hasseus, B.;Stockelberg, D.
与造血SCT（HSCT）相关的预处理治疗会导致肠屏障功能破坏，促进细菌和内毒素透过肠壁，随后增加败血症风险，并在同种异体环境中加重GVHD。Palifermin（重组人角质细胞生长因子）可降低HSCT引起的口腔粘膜炎的严重程度。本试验研究其对肠屏障功能的影响。17例接受自体HSCT的淋巴瘤患者接受了帕利弗明治疗。在预处理治疗前以及第+4天和第+14天评估肠通透性。平行前瞻性评估临床口服和胃肠道毒性。与匹配的历史研究患者（n=21）进行比较。与对照组相比，接受帕利佛明治疗的患者的肠屏障功能明显得到更好的保护（第+4天P=0.01），并且对全肠外营养的需求较少（P=0.005）。未观察到临床胃肠道或口服毒性显著降低。肠屏障功能，通常被破坏的条件治疗，是由帕利弗明保护。肠道屏障保护是否可以防止侵入性感染，以及在同种异体环境中是否可以减轻GVHD的严重程度，仍有待在随机对照试验中研究。骨髓移植（2009）43，807-811; doi：10.1038/bmt.2008.388; 2008年12月1日在线发表
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. Bone Marrow Transplantation (2009) 43, 807-811; doi:10.1038/bmt.2008.388; published online 1 December 2008