Lower vancomycin trough levels in adults undergoing unrelated cord blood transplantation

Yasu, Takeo; Konuma, Takaaki; Oiwa‐Monna, Maki; Kato, Seiko; Isobe, Masamichi; Takahashi, Satoshi; Tojo, Arinobu

doi:10.1080/10428194.2020.1834096

Cited by 5 publications

(9 citation statements)

References 37 publications

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“…5 See Supplementary material for full data extraction. General ARC objective in adult 5,[18][19][20][21] /pediatrics 26 (n = 6) Drug pharmacokinetic/pharmacodynamic alterations in ARC in Adult [22][23][24][25]30 /pediatrics [27][28][29]…”

Section: Resultsmentioning

confidence: 99%

“…While hematologic and solid malignancies were evenly studied with respect to general ARC descriptors in the adult population, 5,18-21 only hematologic malignancies have been studied with respect to drug PK/PD alterations. 22-25,30 All pediatric studies enrolled primarily hematologic malignancies. 26-29 Only 37.6% of adults in general ARC objective publication and 4.6% of pediatric patients enrolled in studies evaluating drug PK/PD were reported to be admitted to the intensive care unit (ICU), however, studies also enrolled patients from oncology-specific units such as stem cell transplantation.…”

Section: Resultsmentioning

confidence: 99%

“…22 One adult and one pediatric publication did not report how renal function was assessed. 25,29 All other pediatric studies utilized the modified Schwartz formula when estimating renal function. [26][27][28] The prevalence of ARC varies widely from 9.8%-100% depending on definition of ARC and method of renal function determination.…”

Section: Arc Definition Determination and Epidemiologymentioning

confidence: 99%

“…23 The 2 publications which reported trough drug levels noted lower vancomycin trough concentrations for patients with ARC. 23,25 A common theme from these studies is that patients with ARC often require higher drug doses or alternative administration techniques to achieve therapeutic goals.…”

Section: Impact On Drug Pharmacokinetic/ Pharmacodynamic Parametersmentioning

confidence: 99%

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Augmented Renal Clearance in the Hematology and Oncology Populations: A Scoping Review for Pharmacists

Nelson

Mendoza

Rhoney

2022

Journal of Pharmacy Practice

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Introduction Until recently, interest in renal function has focused on impairment to limit drug toxicity and increase medication safety. Augmented renal clearance (ARC) has been increasingly studied in multiple patient populations, including oncology, and could lead to decreased drug efficacy from faster elimination resulting in subtherapeutic concentrations. This scoping review sought to summarize ARC literature in cancer and identify areas of research to better inform pharmacy practitioners. Data Sources Electronic databases were searched for English articles related to augmented/enhanced renal function/clearance following a framework for scoping reviews. Data Synthesis Fourteen articles were analyzed, divided according to article objective: descriptive studies or ARC’s impact on pharmacokinetics/pharmacodynamics. ARC was most defined as creatinine clearance >130 mL/min/1.73 m2, reported in 10%-100% of patients. Febrile neutropenia in adult and pediatric patients, and age <50-65 years, hematologic malignancy, and lower serum creatinine in adult patients were notable risk factors for ARC. The impact of ARC has only been evaluated with antimicrobial agents consistently resulting in lower than anticipated trough levels. Identified gaps include: elucidation of ARC’s mechanism and associated biomarkers, an inclusive ARC definition for relative renal enhancement, and study of additional drug classes to ascertain the breadth of ARC impact on drug therapy. Conclusions ARC is proving to be a frequent phenomenon in patients with cancer which pharmacists could play a vital role. Further research is needed to better understand the impact of ARC in patient care and a potential need to stage ARC based on degree of renal enhancement to establish specific drug dosing recommendations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Arc Definition Determination and Epidemiologymentioning

confidence: 99%

Section: Impact On Drug Pharmacokinetic/ Pharmacodynamic Parametersmentioning

confidence: 99%

See 2 more Smart Citations

Augmented Renal Clearance in the Hematology and Oncology Populations: A Scoping Review for Pharmacists

Nelson

Mendoza

Rhoney

2022

Journal of Pharmacy Practice

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“…Despite the development of various pharmacokinetic models and the proposal of a few dosage regimens, there is no consensus on the initial vancomycin dose in patients with hematologic malignancies or neutropenia. None of the international guidelines provide specific recommendations for this subpopulation [4,22].…”

Section: Discussionmentioning

confidence: 99%

Augmented Renal Clearance and Hypoalbuminemia-Induced Low Vancomycin Trough Concentrations in Febrile Neutropenic Patients With Hematological Malignancies

Alzahrani¹,

Hakami²,

AlAzmi³

et al. 2022

Cureus

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Introduction: Vancomycin administration in individuals with hematological malignancy or neutropenia is associated with a suboptimal trough concentration. Nonetheless, most studies did not distinguish whether low vancomycin trough concentrations were due to hematological malignancies or neutropenia. This study aimed to determine the association between types of hematological malignancy and febrile neutropenia with low vancomycin concentrations.Methods: The present retrospective chart review study was conducted by using clinical data adopted from computerized physician order entries (BestCare®) for all of the patients who received intravenous vancomycin treatment between January 2017 and December 2020 at King Abdulaziz Medical City in Jeddah.Results: Out of the 296 patients, 217 were included. There was no significant association between the type of hematological malignancy and the incidence of a low trough concentration (p > 0.05), while a significant association between febrile neutropenia and the incidence of a low trough concentration was observed (p < 0.05). Furthermore, the predictors for a low trough among febrile neutropenic patients were creatinine clearance (CrCI) and a low albumin concentration. In addition, there was a significant association between febrile neutropenia and augmented renal clearance (p < 0.05).Conclusions: The findings of this study conclude that febrile neutropenia is associated with low vancomycin concentrations. Interestingly, augmented renal clearance was observed in most of the febrile neutropenia patients with a significant association, which is considered the main driver for a low trough in neutropenic patients.

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Clinical implications of augmented renal clearance after unrelated single cord blood transplantation in adults

Konuma,

Takano,

Monna-Oiwa

et al. 2023

Int J Hematol

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Augmented renal clearance (ARC) is a phenomenon characterized by increased renal functionality, which can impact the pharmacokinetics and pharmacodynamics of antimicrobial drugs eliminated by the kidneys. It is a potential concern for infection treatment. Cord blood transplantation (CBT) is primarily impeded by delayed neutrophil recovery and immune reconstitution, thereby increasing susceptibility to infection. However, the clinical implications of ARC following CBT remain unexplored. We retrospectively assessed the influence of ARC on post-transplant outcomes at various time points in 194 adult recipients of single-unit unrelated CBT between 2007 and 2022 at our institution. ARC was observed in 52.9% of patients at 1 day, 39.8% at 15 days, and 26.5% at 29 days post-CBT. ARC was not significantly associated with bloodstream infection, acute graft-versus-host disease, or veno-occlusive disease/sinusoidal obstruction syndrome at any time point. ARC at 1 day, 15 days, and 29 days post-CBT was not significantly associated with overall survival, non-relapse mortality, or relapse rates. These findings suggest that ARC is common in adults during the early stages of CBT, but does not discernibly influence clinical outcomes or post-CBT complications.

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Lower vancomycin trough levels in adults undergoing unrelated cord blood transplantation

Cited by 5 publications

References 37 publications

Augmented Renal Clearance in the Hematology and Oncology Populations: A Scoping Review for Pharmacists

Augmented Renal Clearance in the Hematology and Oncology Populations: A Scoping Review for Pharmacists

Augmented Renal Clearance and Hypoalbuminemia-Induced Low Vancomycin Trough Concentrations in Febrile Neutropenic Patients With Hematological Malignancies

Clinical implications of augmented renal clearance after unrelated single cord blood transplantation in adults

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