4.3 Article

Supportive care medications coinciding with chemotherapy among children with hematologic malignancy

Journal

LEUKEMIA & LYMPHOMA
Volume 61, Issue 8, Pages 1920-1931

Publisher

TAYLOR & FRANCIS LTD
DOI: 10.1080/10428194.2020.1749604

Keywords

Polypharmacy; pediatric; cancer; pharmacokinetic; pharmacogenomic; drug interactions

Funding

  1. Primary Children's Hospital Foundation
  2. National Institutes of Health, National Cancer Institute [L40CA220948-01]

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Pharmacokinetic (PK) conflicts can arise between supportive care medications (SCM) and chemotherapy in children with hematologic malignancy (HM). In this retrospective study, medical records for children (28 days-18 years) diagnosed with HM and receiving an SCM antimicrobial were collected from a hospital network between 1 May 2000 and 31 December 2014. PK drug-gene associations were obtained from a curated pharmacogenomics database. Among 730 patients (median age of 7.5 (IQR 3.7-13.9) years), primarily diagnosed with lymphoid leukemia (52%), lymphoma (28%), or acute myeloid leukemia (16%), chemotherapy was administered in 2846 hospitalizations. SCM accounted for 90.5% (n = 448) of distinct drugs with 93% (n = 679) of children, receiving >= 5 different SCM/hospitalization. Same-day SCM/chemotherapeutic PK gene overlap occurred in 48.3% of hospitalizations and was associated with age (p = 0.026), number of SCM, HM subtype, surgery, and hematopoietic stem cell transplant (p < 0.0001). A high and variable SCM burden among children with HM receiving chemotherapy poses a risk for unanticipated PK conflicts.

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