scholarly journals A Guidance for Concomitant Drug Reconciliation Prior to Allogeneic Hematopoietic Cell Transplantation in Children and Young Adults

2021 ◽  
Vol 9 ◽  
Author(s):  
Beth Apsel Winger ◽  
Susie E. Long ◽  
Jordan Brooks ◽  
Ashish O. Gupta ◽  
Christopher C. Dvorak ◽  
...  
Keyword(s):  
Young Adults ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Patient Specific ◽  
Hematopoietic Stem ◽  
Pediatric Diseases ◽  
Conditioning Regimens ◽  
Children And Young Adults ◽  
Concomitant Medications ◽  
Drug Reconciliation

Pediatric diseases treated by allogeneic hematopoietic stem cell transplantation (alloHCT) are complex and associated with significant comorbidities and medication requirements that can complicate the transplant process. It is critical to reconcile pre-transplant concomitant medications (pcon-meds) in the weeks prior to alloHCT and to consider the potential for pcon-meds to cause harmful drug-drug interactions (DDIs) or overlapping toxicities with conditioning agents. In this perspective, we describe a systematic process to review pcon-meds and determine the drug modifications needed to avoid DDIs with conditioning regimens. We provide an extensive appendix with timelines for discontinuation or modification of common pcon-meds that patients are taking when presenting to the HCT medical team. The timelines are based on the pharmacokinetic (PK) properties of both the pcon-meds and the planned conditioning medications, as well as anticipated DDIs. They also account for the ages seen at pediatric transplant centers (0–30 years old). Common scenarios, such as when pcon-med discontinuation is not an option, are discussed. Since alloHCT patients are often dependent upon psychiatric medications with problematic DDIs, a table of alternative, non-interacting psychiatric medications is also presented. The appendix provides details regarding how to adjust pcon-meds prior to the start of chemotherapy for children and young adults undergoing alloHCT, however patient-specific circumstances always need to be taken into account. Careful attentiveness to pcon-meds at the time the decision is made to pursue transplant will result in more consistent HCT outcomes, with lower toxicity and increased efficacy of conditioning agents.

Does Early Lymphocyte Recovery Predict Superior Survival in Children and Young Adults Undergoing Hematopoietic Stem Cell Transplantation?.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5372-5372
Author(s):  
Hamayun Imran ◽  
Shakila P. Khan ◽  
Carola A.S. Arndt ◽  
Vilmarie Rodriguez ◽  
Julia A. Allen ◽  
...  
Keyword(s):  
Young Adults ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Small Sample ◽  
Hematopoietic Stem ◽  
Autologous Transplant ◽  
Children And Young Adults

Abstract Introduction: Early lymphocyte recovery predicts outcome in adults undergoing high dose chemotherapy followed by autologous stem cell transplantation for a variety of malignancies (Porrata et al; 2001, 2002, 2005). Whether rate of lymphoid recovery is predictive of outcome post-hematopoietic stem cell transplantation (HSCT) in children and young adults has not been studied. Objective: To explore the association between early ALC recovery and survival in children and young adults undergoing allogeneic and autologous (HSCT) for leukemia or lymphoma. Methods: Retrospective chart review was performed for all consecutive patients (age 6 months to 21 years) undergoing first HSCT for hematologic malignancies and lymphomas at Mayo Clinic, Division of Pediatric Hematology/Oncology from 1995 to 2004. Day 15 and day 28 ALC were calculated for all patients. The primary end point was 1-year relapse free (RFS) and overall survival (OS). To explore the association between ALC and primary outcome, patients were stratified in 2 groups: ≥ or < than median ALC and Kaplan Meier survival curves were generated for both the groups and compared with the log-rank test. Matched related donor (MRD), matched unrelated donor (MUD) and haploidentical (as one group) and autologous transplantations were analyzed separately. Results: There were a total of 50 patients. 28 received MRD, 2 MUD, 10 haploidentical and 10 autologous transplant. The underlying malignancies were AML n =25, Biphenotypic Leukemia n=1, ALL n =7, NHL n=3, HD n=7, JMML n=5, CML n=2, CLL n=1). No patient was lost to follow up during that time and data was available for all except (day 28 ALC) for one patient. The 1-year RFS and OS rate was the same; 81% for the MRD, 50% for MUD and haploidentical and 70% for autologous transplant populations, respectively. In patients receiving MRD transplants, higher ALC at either day 15 or day 28 post transplantation was associated with better, albeit statistically non-significant, RFS/OS rates at 1 year (85% for ≥ median (0.23) vs. 78% for < median p=0.69 and 86% for ≥ median (0.47) vs. 77% for < median p= 0.59 respectively). Opposite results were observed for MUD and Haploidentical transplantation group (33% for ALC ≥ median (0.05) at day 15 vs. 67% for < median p=0.2, 33% for ALC ≥ median (0.35) at day 28 vs. 66% for < median p=0.28) and for autologous transplantations (67% for ALC ≥ median (0.23) at day 15 vs. 75% for < median p=0.68, 40% for ALC ≥ median (0.48) at day 28 vs. 100% for < median p=0.07). Conclusions: Our data generated conflicting findings of the association between ALC and RFS/OS in different patient populations undergoing HSCT. However, our results are limited by the small sample size. Further collaborative studies are needed to explore this association.

Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Children and Young Adults with Chronic Myeloid Leukemia: A CIBMTR Cohort Analysis

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2534-2534 ◽  
Author(s):  
Sonali Chaudhury ◽  
Nobuko HiJiya ◽  
Zhenhuan Hu ◽  
Rodney Sparapani ◽  
Matt E. Kalaycio ◽  
...  
Keyword(s):  
Young Adults ◽  
Stem Cell ◽  
Chronic Myeloid Leukemia ◽  
Cell Transplantation ◽  
Myeloid Leukemia ◽  
Early Disease ◽  
Hematopoietic Stem ◽  
Allogeneic Hct ◽  
Adjusted Analysis ◽  
Children And Young Adults

Abstract Chronic myeloid leukemia (CML) in pediatrics is rare accounting for 2–3% of leukemias. Data on allogeneic hematopoietic cell transplantation (HCT) in this group is scarce. Since the introduction of tyrosine kinase inhibitors (TKI), HCT in patients with CML especially with early disease has decreased. Children and young adults have long life expectancies, lower morbidity with HCT and are likely to recieve prolonged TKI therapy with increased risk for complications. HCT for early disease may still benefit this population. We retrospectively evaluated outcomes in CML patients receiving myeoloablative HCT reported to the CIBMTR, comparing pediatric patients (n= 212) to young adults (n=200). Table 1 describes patient variables. 5 y overall survival (OS) and leukemia free survival (LFS) in <18 y was 71% (95%CI 65-77) and 51% (95%CI 43-58) respectively. In adjusted analysis, there was a statistically insignificant effect of prior TKI therapy on LFS (P=0.07), OS (0.06), transplant related mortality (TRM) (P=0.47) or relapse (P=0.88). Favorable factors for OS were early disease, matched sibling donors (MSD), bone marrow (BM) or cord blood (CB) grafts. LFS was superior with total body irradiation (TBI), non alemtuzumab based regimens and recent (>2006) HCTs. 5 year OS and LFS for the 18-25y group was 71 (95%CI 65-77)% and 53 (45-60)% respectively. In adjusted analysis there was no difference in OS (P=0.7), LFS (P=0.4) for 18-25y group compared to the pediatric group. Favorable factors for OS/DFS remained early disease, MSD and BM grafts. Allogeneic HCT outcomes were comparable in children and young adults. HCT should remain an option for young patients with CML especially with a MSD using TBI containing regimens with BM as the stem cell source. We could not show an advantage for TKI use prior to HCT. Long term toxicities of TKI and allogeneic HCT need to be further evaluated in this group. Table1 Description of variables for Allogeneic HCT in CML Table1. Description of variables for Allogeneic HCT in CML Figure 1 Adjusted OS and LFS for <18y vs. 18-25y Figure 1. Adjusted OS and LFS for <18y vs. 18-25y Disclosures HiJiya: Pfizer: Consultancy; Jazz: Consultancy; Enzon: Consultancy; Sanofi: Consultancy.

Haploidentical Stem Cell Transplantation for Rare Pediatric Diseases at Peking University People's Hospital

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5848-5848
Author(s):  
Yao Chen ◽  
Huan Chen ◽  
Lan-Ping Xu ◽  
Yu-Hong Chen ◽  
Jing-Zhi Wang ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Conflicts Of Interest ◽  
Conditioning Regimen ◽  
Disease Patient ◽  
Rare Disorders ◽  
Hematopoietic Stem ◽  
Pediatric Diseases ◽  
Conditioning Regimens

Abstract Background:Rare diseases requiring hematopoietic stem cell transplantation (SCT) present a challenge for BMT centers. The patients present at a low frequency, and there are often no established conditioning regimens for these disorders, especially for children without HLA matched sibling donors. We report the conditioning regimen using haploidentical related donors, and outcomes for the following rare disorders transplanted at our center from January 2013 through December 2015. During the past three years we had patients presented with the following: Fanconi anemia (FA), dyskeratosis congenital (DC), adrenal leukodystrophy (ALD) and Wiskott-Aldrich syndrome (WAS). Methods:We treated these children with rare disorders that required SCT at our center, and are reporting the transplant outcomes for these rare diseases. Results: All children were transplanted with haploidentical related donors using G-CSF mobilized bone marrow and peripheral blood stem cell. Conditioning regimens and treatment plans were mainly following Beijing protocol and varied with type of disease. Patient characteristics and outcomes are presented in Table 1. No graft failure occurred and three of 5 patients (60%) are alive and well with no evidence of disease. Conclusions: Our program has treated a variety of rare disorders with an event-free-survival rate of 60%. Our data suggests haploidentical SCT for rare pediatric diseases seems to be challenging and promising. Disclosures No relevant conflicts of interest to declare.

scholarly journals Long-Term Results of Non- Fludarabine Versus Fludarabine-Based Conditioning Regimens in Severe Aplastic Anemia Patients

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5700-5700
Author(s):  
Elifcan Aladag ◽  
Haluk Demiroglu ◽  
Rafiye Ciftciler ◽  
Yahya Buyukasik ◽  
Nilgun Sayinalp ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Conflicts Of Interest ◽  
Therapeutic Modality ◽  
Long Term Results ◽  
Severe Aplastic Anemia ◽  
Hematopoietic Stem ◽  
Primary Graft Failure ◽  
Conditioning Regimens

Abstract BACKGROUND AND OBJECTIVE: Allogenic hematopoietic cell transplantation (AHSCT) is the best therapeutic modality capable of correcting the hematologic manifestations of severe aplastic anemia (SAA), here in this study we have compared the results of well-tolerated fludarabine-based conditioning regimens for SAA patients who are heavily transfused undergoing AHSCT. DESIGN AND SETTINGS: This is a retrospective study consist of 25 patients diagnosed with SAA who underwent AHSCT between February 2002 and March 2015 at the Bone Marrow Transplantation Unit of Hacettepe University. All patients gave written informed consent for the procedure. PATIENTS AND METHODS: We analyzed the outcome of 25 SAA patients who had undergone AHSCT between 2002 and 2015. the median age at transplantation was 27(16-55) years. Patients received transplants from an HLA-identical sibling (n=24) and mismatched allogeneic related HSCT (n=1). Hematopoietic Stem Cells (HSC) were collected from the donors via apheresis. Eight patients underwent standard CY 50 mg/kg plus ATG-FreseniusR 5-10 mg/kg as conditioning fort he transplantation procedure and 13 patients conditioned with CY(50 mg/kg for 2 days) plus fludarabine 25 mg/m2 for 5 days and ATG-FreseniusR 5-10 mg/kg as AHSCT conditioning and received GvHD (Graft-vs-Host Disease) prophylaxis was standard CsA 3 mg/kg IV inf. plus Methotrexate(MTX) 10mg/m2 on day 1,and MTX 5 mg/m2 on days 3.,6. and 11. RESULTS: The median follow-up period for all the survivors was 117 months [minimum 3 and maximum 159 months]. The 5-year overall survival (os) for patients who did or did not receive fludarabine-based preparative regimens for the allograft was 93%, and 87%, respectively. However, there were no statistically significant differences in os rates between these two groups (P=0,58). Median neutrophil engraftment time was 11 days and median platelet engraftment time was 13 days. Primary graft failure occurred in 1 patients (4%) who received fludarabine-based conditioning regimens. CONCLUSION: Fludarabine-Based (Flu-CY-ATG) conditioning is a safe and viable option when compared to the standard CY-ATG conditioning in heavily-transfused SAA patients who undergo Allogeneic hematopoietic stem cell transplantation (allo-HSCT). Disclosures No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document