Background In high-dose methotrexate (HD-MTX) therapy, delayed elimination of MTX from plasma leads to severe adverse effects. However, the risk factors for the delayed elimination of plasma MTX are still unclear. Objective The purpose of this study was to investigate the factors related to the delayed MTX elimination in HD-MTX monotherapy. Methods This retrospective study was performed on patients who received HD-MTX monotherapy between April 2009 and March 2019 at the Hiroshima University Hospital. Patients were divided into a “Normal” and a “Delayed” group according to their MTX plasma concentration at 48 or 72 hours after administration. Patient characteristics, dose of HD-MTX, MTX plasma concentration, and adverse effects were analyzed and compared between the 2 groups. Results A total of 74 patients were included in this study. Logistic analysis of patient baseline characteristics was performed to identify risk factors for delayed MTX elimination. Serum albumin (ALB) was detected as a risk factor. Univariate and multivariate analysis revealed that low ALB level (<3.7 g/dL) and type of cancer were associated with delayed MTX elimination (univariate analysis: odds ratio [OR] = 6.00, P = 0.004, and OR = 4.33, P = 0.039, respectively; multivariate analysis: adjusted OR [AOR] = 6.45, P = 0.006, and AOR = 8.11, P = 0.018, respectively). Adverse effects were not significantly different between the 2 groups, excluding renal impairment. Conclusions and Relevance Our study showed that low ALB is a risk factor for delayed MTX elimination in HD-MTX monotherapy. Pharmacokinetic analysis is needed to establish the dose of HD-MTX in patients with a low ALB level.
When undergoing 90 Y-ibritumomab tiuxetan (90Y-IT) treatment, patients are discharged from hospital soon after initiation of treatment and followed up as outpatients. Thus it is important to apprise patients of the safety information regarding 90Y-IT treatment. However, studies investigating the safety of 90Y-IT in real-world clinical practice are lacking. We sought to investigate the adverse events arising from 90Y-IT administration to patients in our hospital. Patients who received 90Y-IT treatment at Hiroshima University Hospital from April 2010 to December 2014 were eligible for this study. The medical records of the patients were reviewed retrospectively. Eleven patients (median age, 65 years) were enrolled. Patients were classiˆed into 3 groups according to the number of prior regimens: 1, 2 3, or > 3, consisting of 5, 4, and 2 patients, respectively. The number of patients with induced grade 3 and 4 hematotoxicity, respectively, was 5 and 0 for leukocytopenia, 3 and 2 for neutropenia, and 3 and 2 for thrombocytopenia. The median nadir time was 37 d for leukocytopenia, 37 d for neutropenia, 36 d for thrombocytopenia, and 43 d for anemia. Patients with 2 or more prior regimens tended to experience grade 3 or 4 hematotoxicity more frequently than those with 1 prior regimen. In conclusion, we showed that hematotoxicity is a major adverse event of 90Y-IT treatment and that the nadir time is later than that with conventional anticancer agents. Medical staŠ, including pharmacists, should direct attention to the initial symptoms of hematotoxicity, especially in those patients who have received several prior regimens.
The combination of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin with rituximab (DA-EPOCH-R) is used for non-Hodgkin lymphoma patients. Febrile neutropenia (FN) is a common complication of treatment with myelo-suppressive chemotherapy, so preventing FN is important for maintaining chemotherapy dosage. Recently, pegˆlgrastim has been used as the primary prophylaxis of FN in Japan, but there have been few cases reported using pegˆlgrastim for the primary prophylaxis in DA-EPOCH-R. In this study, we retrospectively compared the e‹cacy of pegˆlgrastim with that ofˆlgrastim in patients receiving DA-EPOCH-R in Hiroshima University Hospital. E‹cacy assessment was based on incidence of FN and serious neutropenia (neutrophil count < 500/mL), hospitalization days and chemotherapy dosage level. Ten patients met the inclusion criteria: pegˆlgrastim (n = 5, 30 cycles) orˆlgrastim (n = 5, 16 cycles). No diŠerence in e‹cacy existed between pegˆlgrastim andˆlgrastim in theˆrst cycle; however, 2 of 5 patients inˆlgrastim group reduced dose level in the total cycles of chemotherapy, no patients in peglgrastim group reduced. In conclusion, pegˆlgrastim seemed better thanˆlgrastim for the primary prophylaxis in DA-EPOCH-R.
Ward-based pharmacy interventions are effective for proper medical management. In Hiroshima University Hospital, clinical pharmacists participate in almost all inpatient cases. In addition to the regular clinical pharmacists for the 4 wards, a supervising pharmacist was allocated additionally to overview and to help them as a trial. The supervising pharmacist reviewed the prescriptions and assignments of physicians, and ordered authorized prescriptions. As a result, the number of drug-related incident reports for two months decreased from 17.3 to 3.0, compared to the number of reports of the past three years. The revision of prescriptions by a supervising pharmacist assembly might reduce the inspection workload and number of inquiries by the central pharmacy. On the questionnaire, 94% of physicians expressed a decreased burden during this trial. Also a decreasing trend of overtime work of nursing staff was reported. Therefore, the allocation of a supervising pharmacist may contribute to medical safety and efficient work management of medical staff who are concerned with drug therapy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.