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Yasuda H, Yasuda M, Komatsu N. Chemotherapy for non-Hodgkin lymphoma in the hemodialysis patient: A comprehensive review. Cancer Sci 2021; 112:2607-2624. [PMID: 33938097 PMCID: PMC8253291 DOI: 10.1111/cas.14933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 12/17/2022] Open
Abstract
Chemotherapy for non‐Hodgkin lymphoma (NHL) in the hemodialysis (HD) patient is a challenging situation. Because many drugs are predominantly eliminated by the kidneys, chemotherapy in the HD patient requires special considerations concerning dose adjustments to avoid overdose and toxicities. Conversely, some drugs are removed by HD and may expose the patient to undertreatment, therefore the timing of drug administration in relation to HD sessions must be carefully planned. Also, the metabolites of some drugs show different toxicities and dialysability as compared with the parent drug, therefore this must also be catered for. However, the pharmacokinetics of many chemotherapeutics and their metabolites in HD patients are unknown, and the fact that NHL patients are often treated with distinct multiagent chemotherapy regimens makes the situation more complicated. In a realm where uncertainty prevails, case reports and case series reporting on actual treatment and outcomes are extremely valuable and can aid physicians in decision making from drug selection to dosing. We carried out an exhaustive review of the literature and adopted 48 manuscripts consisting of 66 HD patients undergoing 71 chemotherapy regimens for NHL, summarized the data, and provide recommendations concerning dose adjustments and timing of administration for individual chemotherapeutics where possible. The chemotherapy regimens studied in this review include, but are not limited to, rituximab, cyclophosphamide + vincristine + prednisolone (CVP) and cyclophosphamide + doxorubicin + vincristine + prednisolone (CHOP)‐like regimens, chlorambucil, ibrutinib, bendamustine, methotrexate, platinum compounds, cytarabine, gemcitabine, etoposide, ifosfamide, melphalan, busulfan, fludarabine, mogamulizumab, brentuximab vedotin, and 90Y‐ibritumomab tiuxetan.
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Affiliation(s)
- Hajime Yasuda
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Mutsuko Yasuda
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
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Thompson A, Li F, Gross AK. Considerations for Medication Management and Anticoagulation During Continuous Renal Replacement Therapy. AACN Adv Crit Care 2017; 28:51-63. [PMID: 28254856 DOI: 10.4037/aacnacc2017386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Providing safe and high-quality care to critically ill patients receiving continuous renal replacement therapy (CRRT) includes adequate drug dosing and evaluation of patients' response to medications during therapy. Pharmacokinetic drug studies in acute kidney injury and CRRT are limited, considering the number of medications used in critical care. Therefore, it is important to understand the basic principles of drug clearance during CRRT by evaluating drug properties, CRRT modalities, and how they affect medication clearance. Few published studies have addressed drug disposition and clinical response during CRRT. Additionally, clotting in the CRRT circuit is a concern, so a few options for anticoagulation strategies are presented. This article reviews (1) the CRRT system and drug property factors that affect medication management, (2) the evidence available to guide drug dosing, and (3) anticoagulation strategies for critically ill patients receiving CRRT.
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Affiliation(s)
- Ashley Thompson
- Ashley Thompson is Critical Care Pharmacist, Senior Pharmacist Supervisor, University of California, San Francisco (UCSF) Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, 533 Parnassus Ave. Box 0622, San Francisco, CA 94143 . Fanny Li is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Fran-cisco, California. A. Kendall Gross is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, California
| | - Fanny Li
- Ashley Thompson is Critical Care Pharmacist, Senior Pharmacist Supervisor, University of California, San Francisco (UCSF) Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, 533 Parnassus Ave. Box 0622, San Francisco, CA 94143 . Fanny Li is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Fran-cisco, California. A. Kendall Gross is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, California
| | - A Kendall Gross
- Ashley Thompson is Critical Care Pharmacist, Senior Pharmacist Supervisor, University of California, San Francisco (UCSF) Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, 533 Parnassus Ave. Box 0622, San Francisco, CA 94143 . Fanny Li is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Fran-cisco, California. A. Kendall Gross is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, California
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Cytosine arabinoside and daunorubicin induction therapy in a patient with acute myeloid leukemia on chronic hemodialysis. Anticancer Drugs 2016; 27:800-3. [DOI: 10.1097/cad.0000000000000382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Niscola P, Vischini G, Tendas A, Scaramucci L, Giovannini M, Bondanini F, Romani C, Brunetti GA, Cartoni C, Cupelli L, Ferrannini M, Perrotti A, Del Poeta G, Palumbo R, de Fabritiis P. Management of hematological malignancies in patients affected by renal failure. Expert Rev Anticancer Ther 2011; 11:415-32. [PMID: 21417855 DOI: 10.1586/era.11.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The management of hematological malignancies (HM) in renally impaired patients may be a difficult task. Indeed, the kidney represents a major elimination pathway for many chemotherapeutic agents and their metabolites, whose serum levels are not usually measured in daily clinical practice. In addition, many antineoplastic drugs have a narrow therapeutic index for which they require dose adjustment when administered to patients with renal failure. Only limited data regarding the use of chemotherapy in patients with renal impairment and in those on dialysis are available. Indeed, renal patients with HM are often excluded from most clinical trials. Thus far, in order to provide recommendations, we have reviewed the pertinent literature, gathering information from published guidelines regarding chemotherapy in patients with kidney dysfunction and from articles describing the use of individual agents in renal patients with HM.
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Radeski D, Cull GM, Cain M, Hackett LP, Ilett KF. Effective clearance of Ara-U the major metabolite of cytosine arabinoside (Ara-C) by hemodialysis in a patient with lymphoma and end-stage renal failure. Cancer Chemother Pharmacol 2010; 67:765-8. [DOI: 10.1007/s00280-010-1373-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 05/17/2010] [Indexed: 10/19/2022]
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Aravindan AN, Saunders J, Cleland B, Spicer T, Howlin K, Wong J, Jefferys A, Chow J, Henderson C, Suranyi M. Pyrexia of unknown origin (PUO) in a hemodialysis patient. Int Urol Nephrol 2007; 39:1277-80. [PMID: 17899425 DOI: 10.1007/s11255-007-9285-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 08/22/2007] [Indexed: 12/01/2022]
Abstract
Patients with end stage renal disease (ESRD) are predisposed to malignancy. A patient who presented with a persisting fever, episodically above 38 degrees C, of unknown origin is described. The diagnosis of the illness remained elusive, over repeated hospital admissions and comprehensive investigations for over 11 weeks, until her last admission when the patient finally represented with features of acute liver cell failure and succumbed shortly afterwards. A liver biopsy revealed high grade lymphoma, an uncommon presentation for lymphoma. While malignancy is increased in dialysis patients, lymphoma is a relatively uncommon malignancy described. This case is a rare incidence of diffuse Non-Hodgkin's Lymphoma (NHL) isolated to the liver, causing fever, liver cell failure and death in a hemodialysis patient.
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Takeuchi M, Yamauchi T, Yoshida I, Soda R, Ueda T, Takahashi K. Pharmacokinetics of a standard dose of cytarabine in a patient with acute promyelocytic leukemia undergoing continuous ambulatory peritoneal dialysis. Int J Hematol 2003; 77:196-8. [PMID: 12627859 DOI: 10.1007/bf02983222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Crews KR, Wimmer PS, Hudson JQ, Howard SC, Ribeiro RC, Razzouk BI. Pharmacokinetics of 2-chlorodeoxyadenosine in a child undergoing hemofiltration and hemodialysis for acute renal failure. J Pediatr Hematol Oncol 2002; 24:677-80. [PMID: 12439044 DOI: 10.1097/00043426-200211000-00016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The clearance of 2-chlorodeoxyadenosine (2-CdA) in patients with renal insufficiency has not been characterized previously. The authors describe the clinical course and the pharmacokinetics of 2-CdA in a child with acute monoblastic leukemia who experienced acute renal failure during treatment with cytarabine and 2-CdA. 2-CdA (9 mg/m per day) was infused over 30 minutes daily for 5 days. Plasma and dialysate concentrations of 2-CdA were measured by high-performance liquid chromatography. The rate of this patient's 2-CdA clearance was lower than the rates reported for children with normal renal function. The average clearance rate, reflecting systemic clearance and clearance by continuous venovenous hemofiltration and hemodialysis, was 12.4 L/hour per m for the first 3 days of 2-CdA therapy. He did not experience untoward hematologic toxicity. Because high 2-CdA plasma concentrations were observed in this patient, clinicians are advised to exercise caution when using this drug in patients with renal dysfunction. More experience in the administration of 2-CdA to patients with renal insufficiency will be necessary to determine the need for dosage adjustment.
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Affiliation(s)
- Kristine R Crews
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794, USA.
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Duda J, Zoger S. Presentation of M4 acute myeloid leukemia in anuric renal failure with hyperuricemia and enlarged kidneys. J Pediatr Hematol Oncol 2002; 24:55-8. [PMID: 11902742 DOI: 10.1097/00043426-200201000-00015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Extramedullary acute myeloid leukemia (AML) is not uncommon. It has been shown to involve the kidneys in most postmortem cases but is most often clinically insignificant. By contrast, acute tumor lysis syndrome is rare in AML, especially at initial diagnosis. The authors report the management of a patient with AML who had acute tumor lysis syndrome that was probably potentiated by renal leukemia and resulted in renal failure. This patient achieved remission with dose-modified induction chemotherapy administered while he was dialysis-dependent.
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Affiliation(s)
- Jennifer Duda
- Division of Pediatric Hematology/Oncology, University of California-San Francisco School of Medicine, USA.
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Abstract
Mortality trends were analyzed in 441 children and adolescents with chronic renal failure (CRF) observed over a 24-year period before and after institution of renal replacement therapy (RRT). A total of 93 patients died. Overall mortality rate (MR) per 100 patient years decreased from 6.6 in 1969-1978 to 2.5 in 1979-1988 and increased slightly to 2.9 in 1989-1992. The fall involved all four modes of treatment: conservative, hemodialysis (HD), continuous peritoneal dialysis (CPD), and transplantation (TX). From 1979-1988 to 1989-1992 MR on conservative and on dialysis treatment changed only slightly and was similar on HD and CPD. An alarming rise in MR was noted after TX in 1989-1992, mainly due to malignant tumors. In 44 patients who died on conservative treatment, the reasons for non-acceptance for RRT were analyzed: in 22 multi-morbidity was the main reason, usually because of a congenital neurological disorder. Some patients died from advanced uremia or unexpected events after the decision to institute RRT. Our experience demonstrates a persistent mortality in pediatric patients with CRF, which in recent years is primarily ascribed to congenital multi-morbid conditions which make RRT unfeasible, infections on dialysis treatment, and malignancies after TX.
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Affiliation(s)
- U Reiss
- Division of Pediatric Nephrology, University Children's Hospital, Heidelberg, Germany
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