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Supportive care medications coinciding with chemotherapy among children with hematologic malignancy

Eman Biltaji1, Elena Y Enioutina1, Venkata Yellepeddi1

  • 1Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA.

Leukemia & Lymphoma
|April 9, 2020
PubMed

Insights

Supportive care medications (SCM) and chemotherapy can cause pharmacokinetic (PK) conflicts in children with hematologic malignancy (HM). A study found PK gene overlap in nearly half of hospitalizations, highlighting a risk for adverse drug interactions.

Area of Science:

  • Pharmacology
  • Pediatric Oncology
  • Pharmacogenomics

Background:

  • Pharmacokinetic (PK) interactions between supportive care medications (SCM) and chemotherapy are a concern in pediatric hematologic malignancy (HM).
  • Understanding these PK conflicts is crucial for optimizing treatment and minimizing adverse events in young patients.

Purpose of the Study:

  • To investigate the frequency and associations of PK gene overlap between SCM and chemotherapy in children with HM.
  • To identify factors contributing to potential PK conflicts in this vulnerable population.

Main Methods:

  • Retrospective analysis of medical records for children (28 days-18 years) with HM receiving SCM antimicrobials.
  • Utilized a pharmacogenomics database to identify PK drug-gene associations.
  • Examined same-day SCM and chemotherapeutic PK gene overlap across hospitalizations.

Main Results:

  • Nearly half (48.3%) of hospitalizations showed same-day SCM/chemotherapeutic PK gene overlap.
  • This overlap was associated with patient age, number of SCMs, HM subtype, surgery, and hematopoietic stem cell transplant.
  • Children with HM received a high burden of SCMs, with 93% receiving at least five different SCMs per hospitalization.

Conclusions:

  • A significant proportion of pediatric HM patients undergoing chemotherapy experience PK gene overlap with supportive care medications.
  • The high and variable SCM burden in these children presents a substantial risk for unanticipated PK conflicts.
  • Further research and clinical strategies are needed to mitigate these PK interactions.

Keywords:
Polypharmacycancerdrug interactionspediatricpharmacogenomicpharmacokinetic

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