Efecto adverso de los anticonvulsivos sobre la eficacia de la quimioterapia para la leucemia linfoblástica aguda
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Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia
Published on: September 18, 2013
M V Relling1, C H Pui, J T Sandlund
1St Jude Children's Research Hospital, Memphis, TN 38105, USA. mary.relling@stjude.org
Lancet (London, England)
|November 9, 2000
Resumen
Los medicamentos anticonvulsivos pueden reducir la efectividad de la quimioterapia para la leucemia linfoblástica aguda al aumentar el aclaramiento de los agentes antileucémicos. Considere los anticonvulsivos alternativos para los pacientes sometidos a tratamiento contra el cáncer.
Área de la Ciencia:
- Farmacología Farmacología.
- Oncología Oncología.
- Hematología/Oncología Pediátrica.
Sus antecedentes:
- Las enzimas hepáticas metabolizan muchos medicamentos antileucémicos.
- Los medicamentos anticonvulsivos a menudo inducen estas enzimas hepáticas, acelerando el aclaramiento de los medicamentos anticancerígenos.
- Esta interacción plantea preocupaciones sobre la eficacia comprometida de la quimioterapia contra el cáncer.
Objetivo del estudio:
- Investigar si el uso simultáneo de anticonvulsivos afecta la efectividad de la quimioterapia contra el cáncer en niños.
- Evaluar la relación entre la terapia anticonvulsivante y los resultados del tratamiento en la leucemia linfoblástica aguda (LLA).
Principales métodos:
- Se analizó una cohorte de 716 niños con leucemia linfoblástica aguda (LLA) tratados entre 1984-1994.
- Se identificaron pacientes que recibían anticonvulsivos simultáneos (fenitoína, fenobarbital, carbamazepina) con tratamiento antileucémico.
- Los modelos de riesgos proporcionales de Cox evaluaron el impacto de los anticonvulsivantes en la supervivencia libre de eventos y el riesgo de recaída.
Principales resultados:
- El 5,6% de los pacientes recibieron anticonvulsivos, asociados con la edad avanzada y la ALL de células T.
- El uso de anticonvulsivos se correlacionó significativamente con una peor supervivencia libre de eventos, mayores tasas de recaída hematológica y recaída del SNC en la LLA de linaje B.
- Se observó una depuración más rápida de la teniposida y el metotrexato en pacientes que usaban anticonvulsivos.
Conclusiones:
- La terapia anticonvulsivante a largo plazo puede disminuir la eficacia de la quimioterapia para la leucemia linfoblástica aguda (LLA).
- Esto está relacionado con un aumento del aclaramiento sistémico de los principales agentes antileucémicos.
- Se recomiendan anticonvulsivos alternativos no inductores de enzimas para todos los pacientes que reciben quimioterapia.
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