Hand-Foot Syndrome (HFS) in Hematopoietic Stem Cell Transplant (HSCT) Patients: Effect of Total Body Irradiation (TBI), Etoposide (VP16) and Palifermin

Background

HFS, an adverse reaction associated with certain chemotherapeutic agents, is characterized by dysesthesias in hands and feet. No cases of HFS with total body irradiation (TBI) or etoposide (VP16) have been reported in the literature, but a few cases have been reported with palifermin.

Objective

To determine the incidence, onset, duration, severity and risk factors for HFS in patients receiving TBI/VP16 ± palifermin, and to evaluate the effects of palifermin on the development of HFS. 

Method

An institutional review board-approved retrospective cohort study of adult allogeneic HSCT patients at City of Hope receiving TBI/VP16 (control) and TBI/VP16/palifermin (palifermin) was conducted during 2 specific time periods. The occurrence of HFS was determined through review of medical records.

Results

Incidence of HFS was 38% and 40% in the control (n=58) and palifermin (n=58) groups (Fisher’s exact, p=0.85). Mean duration of HFS was 16.8 and 11 days (t-test, p=0.015). Mean onset of HFS occurred on day +7.6 and +3.7 (t-test, p=0.0001). Severe HFS occurred in 43% and 13% (Fisher’s exact, p=0.07). Severity of HFS was associated with duration in the palifermin group (Spearman r=0.85, p<0.0001). Females and patients who developed early skin reactions to palifermin were more likely to develop HFS (Fisher’s exact, p=0.01 and p=0.04). Age, donor type, and palifermin dosing schedule were not risk factors for development of HFS.

Conclusion

TBI/VP16 was associated with a 38-40% incidence of HFS. Palifermin significantly reduced time to onset and decreased duration of HFS and offers a previously unreported benefit in this patient population. Female gender and early skin reaction to palifermin were risk factors for HFS.