1
|
D'Aragon F, Selzner M, Breau R, Masse MH, Lamontagne F, Masse M, Chassé M, Carrier FM, Cardinal H, Chaudhury P, Weiss M, Lauzier F, Turgeon AF, Frenette AJ, Bolduc B, Ducharme A, Lamarche C, Couture E, Holdsworth S, Bertholz L, Talbot H, Slessarev M, Luke P, Boyd JG, Shamseddin MK, Burns KEA, Zaltzman J, English S, Knoll G, Dhanani S, Healey A, Hanna S, Rochwerg B, Oczkowski SJW, Treleaven D, Meade M. Calcineurin Inhibitor in NEuRoloGically deceased donors to decrease kidney delayed graft function study: study protocol of the CINERGY Pilot randomised controlled trial. BMJ Open 2024; 14:e086777. [PMID: 38871657 PMCID: PMC11177676 DOI: 10.1136/bmjopen-2024-086777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Most solid organ transplants originate from donors meeting criteria for death by neurological criteria (DNC). Within the organ donor, physiological responses to brain death increase the risk of ischaemia reperfusion injury and delayed graft function. Donor preconditioning with calcineurin inhibition may reduce this risk. METHODS AND ANALYSIS We designed a multicentre placebo-controlled pilot randomised trial involving nine organ donation hospitals and all 28 transplant programmes in the Canadian provinces of Ontario and Québec. We planned to enrol 90 DNC donors and their approximately 324 organ recipients, totalling 414 participants. Donors receive an intravenous infusion of either tacrolimus 0.02 mg/kg over 4 hours prior to organ retrieval, or a matching placebo, while monitored in an intensive care unit for any haemodynamic changes during the infusion. Among all study organ recipients, we record measures of graft function for the first 7 days in hospital and we will record graft survival after 1 year. We examine the feasibility of this trial with respect to the proportion of all eligible donors enrolled and the proportion of all eligible transplant recipients consenting to receive a CINERGY organ transplant and to allow the use of their health data for study purposes. We will report these feasibility outcomes as proportions with 95% CIs. We also record any barriers encountered in the launch and in the implementation of this trial with detailed source documentation. ETHICS AND DISSEMINATION We will disseminate trial results through publications and presentations at participating sites and conferences. This study has been approved by Health Canada (HC6-24-c241083) and by the Research Ethics Boards of all participating sites and in Québec (MP-31-2020-3348) and Clinical Trials Ontario (Project #3309). TRIAL REGISTRATION NUMBER NCT05148715.
Collapse
Affiliation(s)
- Frederick D'Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Markus Selzner
- Multi-Organ Transplant Program, Toronto General Hospital, Toronto, Quebec, Canada
- Department of General Surgery, University of Toronto and Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ruth Breau
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Marie-Hélène Masse
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Francois Lamontagne
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mélanie Masse
- Department of Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michael Chassé
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - François-Martin Carrier
- Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Héloïse Cardinal
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Prosanto Chaudhury
- Department of Surgery and Oncology, McGill University, Montreal, Québec, Canada
- Transplant Québec, Montréal, Québec, Canada
| | - Matthew Weiss
- Transplant Québec, Montreal, Québec, Canada
- Population Health and Optimal Health Practives Research Unit (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec - Université Laval, Quebec, Quebec, Canada
| | - Francois Lauzier
- Population Health and Optimal Health Practives Research Unit (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec - Université Laval, Quebec, Quebec, Canada
- Department of Medicine, Université Laval, Québec City, Québec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practives Research Unit (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec - Université Laval, Quebec, Quebec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | | | - Brigitte Bolduc
- Department of Pharmacy, Centre integre universitaire de sante et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anique Ducharme
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
- Montreal Heart Institute, Montreal, Québec, Canada
| | - Caroline Lamarche
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
- Hôpital Maisonneuve-Rosemont Research Institute, Montréal, Québec, Canada
| | - Etienne Couture
- Department of Anesthesiology and Critical Care, Quebec Heart & Lung Institute, Université Laval, Quebec, Quebec, Canada
| | - Sandra Holdsworth
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
| | - Liz Bertholz
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
| | - Heather Talbot
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
| | - Marat Slessarev
- Department of Medicine, Division of Critical Care, Western University, London, Ontario, Canada
| | - Patrick Luke
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - John Gordon Boyd
- Department of Medicine, Division of Neurology, Queen's University, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - M Khaled Shamseddin
- Department of Medicine, Division of Nephrology, Queen's University, Kingston, Ontario, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, University Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jeffrey Zaltzman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shane English
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Greg Knoll
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sonny Dhanani
- Department of Pediatrics, Division of Critical Care, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Healey
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Steven Hanna
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Darin Treleaven
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Maureen Meade
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
2
|
Williams M, Gul Z, Graff J, Mejaki B, Sana S, Medlin S. Comparison of intermittent intravenous tacrolimus to continuous tacrolimus in adult allogeneic stem cell transplant recipients. J Oncol Pharm Pract 2024:10781552241252606. [PMID: 38706250 DOI: 10.1177/10781552241252606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Introduction: Initial continuous intravenous (CIV) tacrolimus (0.03 mg/kg/day based on ideal body weight [IBW]) has been favored for graft versus host disease (GVHD) prevention in allogeneic stem cell transplant patients due to the consistent, steady-state degree of immunosuppression; however, this method poses many logistical challenges. We implemented intermittent (IIV) tacrolimus at a starting dose of 0.015 mg/kg IBW twice daily over 4 h. To our knowledge this is the first retrospective comparison of CIV to IIV tacrolimus. Objectives: The primary objective was to evaluate the safety of IIV tacrolimus in comparison to CIV with respect to nephrotoxicity and neurotoxicity. The secondary objectives were to compare the incidence of grade II-IV acute GVHD (aGVHD) and chronic GVHD (cGVHD) at day +180, outcomes including relapse and overall survival, cell engraftment, and reactivation of cytomegalovirus and Epstein-Barr virus. Methods: This retrospective, single-center review evaluated adults who received an allogeneic stem cell transplant patients between January 1, 2020, and December 31, 2022. Results: Fifty-one unique patients were eligible for evaluation - 28 in the IIV cohort and 23 in the CIV group. The number of patients who developed nephrotoxicity and neurotoxicity were comparable between groups with no significant differences noted. No severe neurotoxicity was identified in either population. Secondary objectives revealed no significant difference in GVHD incidence or survival outcomes. Conclusion: IIV tacrolimus is comparable to CIV in terms of safety while also maintaining similar outcomes at day +180. IIV is a safe and feasible alternative to CIV in adult allogeneic stem cell transplant recipients.
Collapse
Affiliation(s)
- Michael Williams
- Malignant Hematology and Stem Cell Transplant, Aurora St Luke's Medical Center, Milwaukee, WI, USA
- Department of Pharmacy, Aurora St Luke's Medical Center, Milwaukee, WI, USA
| | - Zartash Gul
- Malignant Hematology and Stem Cell Transplant, Aurora St Luke's Medical Center, Milwaukee, WI, USA
| | - Justin Graff
- Malignant Hematology and Stem Cell Transplant, Aurora St Luke's Medical Center, Milwaukee, WI, USA
- Department of Pharmacy, Aurora St Luke's Medical Center, Milwaukee, WI, USA
| | - Brittany Mejaki
- Malignant Hematology and Stem Cell Transplant, Aurora St Luke's Medical Center, Milwaukee, WI, USA
- Department of Pharmacy, Aurora St Luke's Medical Center, Milwaukee, WI, USA
| | - Sherjeel Sana
- Malignant Hematology and Stem Cell Transplant, Aurora St Luke's Medical Center, Milwaukee, WI, USA
| | - Stephen Medlin
- Malignant Hematology and Stem Cell Transplant, Inova Schar Cancer Institute, Fairfax, VA, USA
| |
Collapse
|
3
|
Zhumatayev S, Yalcin K, Celen SS, Karaman I, Daloglu H, Ozturkmen S, Uygun V, Karasu G, Yesilipek A. Comparison of tacrolimus vs. cyclosporine in pediatric hematopoietic stem cell transplantation for thalassemia. Pediatr Transplant 2024; 28:e14688. [PMID: 38317344 DOI: 10.1111/petr.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Graft-versus-host disease (GvHD) is one of the leading causes of morbidity and mortality in patients undergoing allogeneic HSCT, and effective prevention of GvHD is critical for the success of the HSCT procedure. Calcineurin inhibitors (CNI) have been used for decades as the backbone of GvHD prophylaxis. In this study, the efficacy and safety of Cyclosporine A (CsA) and tacrolimus (TCR) were compared in pediatric HSCT for thalassemia. MATERIALS AND METHODS This is a retrospective analysis of 129 pediatric patients who underwent HSCT with the diagnosis of thalassemia at Medicalpark Göztepe and Antalya Hospitals between January 2017 and December 2020. RESULTS Despite the GvHD prophylaxis, grade II-IV acute GvHD developed in 29 patients. Of these patients, 12 had only gut, 10 had only skin, 6 had combined gut and skin, and one had only liver GvHD. Fifteen of these 29 patients were in the CsA group, and 14 of them were in the TCR group. There was no significant difference between the groups in terms of acute GvHD occurrence, GvHD stage, or involvement sites. In terms of CNI-related toxicity, neurotoxicity in 15 (CsA n = 9, TCR n = 6) and nephrotoxicity in 18 (CsA n = 4, TCR n = 14) patients were observed. While there was no difference between the two groups in terms of neurotoxicity, more nephrotoxicity developed in patients using TCR (p = .013). There was no significant difference between the groups in terms of engraftment syndrome, veno-occlusive disease, CMV reactivation, PRES, or graft rejection. CONCLUSION Regarding GvHD, there was no difference in efficacy between TCR and CsA usage. Patients taking TCR experienced noticeably higher nephrotoxicity in terms of adverse effects. This difference should be considered according to the patient's clinical situation while choosing a CNI.
Collapse
Affiliation(s)
- Suleimen Zhumatayev
- Department of Pediatric Hematology and Oncology, Goztepe Medical Park Hospital, Istanbul, Turkey
| | - Koray Yalcin
- Department of Pediatric Hematology and Oncology, Bahcesehir University, Goztepe Medical Park Hospital, Istanbul, Turkey
- Department of Medical Biotechnology, Institute of Health Science, Acibadem University, Istanbul, Turkey
| | - Safiye Suna Celen
- Department of Pediatric Hematology and Oncology, Bahcesehir University, Goztepe Medical Park Hospital, Istanbul, Turkey
| | - Irem Karaman
- Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Hayriye Daloglu
- Department of Pediatric Hematology and Oncology, Antalya Medical Park Hospital, Antalya, Turkey
| | - Seda Ozturkmen
- Department of Pediatric Hematology and Oncology, Antalya Medical Park Hospital, Antalya, Turkey
| | - Vedat Uygun
- Department of Pediatric Hematology and Oncology, Istinye University, Goztepe Medical Park Hospital, Istanbul, Turkey
| | - Gulsun Karasu
- Department of Pediatric Hematology and Oncology, Goztepe Medical Park Hospital, Istanbul, Turkey
- Department of Pediatric Hematology and Oncology, Antalya Medical Park Hospital, Antalya, Turkey
| | - Akif Yesilipek
- Department of Pediatric Hematology and Oncology, Goztepe Medical Park Hospital, Istanbul, Turkey
- Department of Pediatric Hematology and Oncology, Antalya Medical Park Hospital, Antalya, Turkey
| |
Collapse
|
4
|
Zuo M, Shang Y, Guo Y, Sun Y, Xu G, Chen J, Zhu L. Population Pharmacokinetics of Tacrolimus in Pediatric Patients With Umbilical Cord Blood Transplant. J Clin Pharmacol 2023; 63:298-306. [PMID: 36196568 DOI: 10.1002/jcph.2162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022]
Abstract
Tacrolimus was frequently used in pediatric patients with umbilical cord blood transplant for the prevention of graft-versus-host disease. The aim of the present study was to evaluate the population pharmacokinetics of tacrolimus among pediatric patients with umbilical cord blood transplant and find potential influenced factors. A total of 275 concentrations from 13 pediatric patients were used to build a polulation pharmacokinetic model using a nonlinear mixed-effects modeling approach. The impact of demographic features, biological characteristics, and concomitant medications, including sex, age, body weight, postoperative day, white blood cell count, red blood cell count, hemoglobin, platelets, hematocrit, blood urea nitrogen, creatinine, aspartate transaminase, alanine transaminase, total bilirubin, albumin, and total protein were investigated. The pharmacokinetics of tacrolimus were best described by a 1-compartment model with first- and zero-order mixed absorption and first-order elimination. The clearance and volume of distribution of tacrolimus were 1.93 L/h and 75.1 L, respectively. A covariate analysis identified that postoperative day and co-administration with trimethoprim-sulfamethoxazole were significant covariates influencing clearance of tacrolimus. Frequent blood monitoring and dose adjustment might be needed with the prolongation of postoperative day and coadministration with trimethoprim-sulfamethoxazole.
Collapse
Affiliation(s)
- Meiling Zuo
- Pharmaceutical College, Tianjin Medical University, Tianjin, China
| | - Yue Shang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Ye Guo
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yuxuan Sun
- Pharmaceutical College, Tianjin Medical University, Tianjin, China
| | - Gaoqi Xu
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Jingtao Chen
- School of Statistics and Data Science, Nankai University, Tianjin, China
| | - Liqin Zhu
- Pharmaceutical College, Tianjin Medical University, Tianjin, China.,Department of Pharmacy, Tianjin First Central Hospital, Tianjin, China
| |
Collapse
|
5
|
Radhakrishnan A, Kuppusamy G, Ponnusankar S, Mutalik S. Towards next-generation personalization of tacrolimus treatment: a review on advanced diagnostic and therapeutic approaches. Pharmacogenomics 2021; 22:1151-1175. [PMID: 34719935 DOI: 10.2217/pgs-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The benefit of personalized medicine is that it allows the customization of drug therapy - maximizing efficacy while avoiding side effects. Genetic polymorphisms are one of the major contributors to interindividual variability. Currently, the only gold standard for applying personalized medicine is dose titration. Because of technological advancements, converting genotypic data into an optimum dose has become easier than in earlier years. However, for many medications, determining a personalized dose may be difficult, leading to a trial-and-error method. On the other hand, the technologically oriented pharmaceutical industry has a plethora of smart drug delivery methods that are underutilized in customized medicine. This article elaborates the genetic polymorphisms of tacrolimus as case study, and extensively covers the diagnostic and therapeutic technologies which aid in the delivery of personalized tacrolimus treatment for better clinical outcomes, thereby providing a new strategy for implementing personalized medicine.
Collapse
Affiliation(s)
- Arun Radhakrishnan
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Nilgiris, Tamilnadu, India
| | - Gowthamarajan Kuppusamy
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Nilgiris, Tamilnadu, India
| | - Sivasankaran Ponnusankar
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Nilgiris, Tamilnadu, India
| | - Srinivas Mutalik
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Karnataka, India
| |
Collapse
|
6
|
Yalcin K, Celen S, Zhumatayev S, Daloglu H, Pashayev D, Öztürkmen S, Uygun V, Karasu G, Yesilipek A. Analyzing the clinical outcomes of switching from cyclosporine to tacrolimus in pediatric hematopoietic stem cell transplantation. Clin Transplant 2021; 35:e14328. [PMID: 33896035 DOI: 10.1111/ctr.14328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The selection of graft-vs. -host disease (GvHD) prophylaxis is vital for the success of hematopoetic stem cell transplantation (HSCT), and calcineurin inhibitors (CNI) have been used for decades as the backbone of GvHD prophylaxis. The aim of this study is to analyze the results of switching cyclosporine (CSA) to tacrolimus because of acute GvHD, engraftment syndrome (ES), persistent low level of CSA, or various CSA-associated adverse events in the first 100 days of pediatric HSCT. MATERIALS AND METHODS This is a retrospective analysis of 192 patients who underwent allogeneic hematopoietic stem cell transplantation at Medicalpark Göztepe and Antalya Hospitals between April 2014 and May 2019 had therapy switched from CSA to tacrolimus-based immunosuppression within 100 days of transplant. RESULTS The reasons for conversion to tacrolimus were low level of CSA (n = 70), aGvHD (n = 63), CSA-associated neurotoxicity (n = 15), CSA-associated nephrotoxicity (n = 10), hypertension (n = 10), allergic reactions (n = 9), ES (n = 7), CSA-associated hepatotoxicity (n = 5), and vomiting (n = 3). The median day after transplant for conversion to tacrolimus for all patients was day 20 (range 0-100 days). Response rates to conversion were 38% for GvHD, 86% for neurotoxicity, 50% for nephrotoxicity, 60% for hepatotoxicity, 80% for hypertension, 66% for vomiting, and 57% for ES. Twenty-nine patients (15%) experienced tacrolimus-associated toxicities after therapy conversion to tacrolimus. Neurotoxicity emerged as posterior reversible encephalopathy syndrome (PRES), which was the most common toxicity observed after conversion (18/29 patients). CONCLUSION Our data support the quick conversion to tacrolimus in the condition of persistent low CSA levels with acceptable efficacy and safety. Although both drugs are CNI and share a very similar mechanism of action, the conversion could be preferred especially in specific organ toxicities with special attention for neurotoxicity after conversion.
Collapse
Affiliation(s)
- Koray Yalcin
- MedicalPark Goztepe Hospital, Pediatric Bone Marrow Transplantation Unit, Istanbul, Turkey
| | - Suna Celen
- MedicalPark Goztepe Hospital, Pediatric Bone Marrow Transplantation Unit, Istanbul, Turkey
| | - Suleimen Zhumatayev
- MedicalPark Goztepe Hospital, Pediatric Bone Marrow Transplantation Unit, Istanbul, Turkey
| | - Hayriye Daloglu
- MedicalPark Antalya Hospital, Pediatric Bone Marrow Transplantation Unit, Antalya, Turkey
| | - Dayanat Pashayev
- MedicalPark Goztepe Hospital, Pediatric Bone Marrow Transplantation Unit, Istanbul, Turkey
| | - Seda Öztürkmen
- MedicalPark Antalya Hospital, Pediatric Bone Marrow Transplantation Unit, Antalya, Turkey
| | - Vedat Uygun
- MedicalPark Antalya Hospital, Pediatric Bone Marrow Transplantation Unit, Antalya, Turkey
| | - Gulsun Karasu
- MedicalPark Goztepe Hospital, Pediatric Bone Marrow Transplantation Unit, Istanbul, Turkey
| | - Akif Yesilipek
- MedicalPark Goztepe Hospital, Pediatric Bone Marrow Transplantation Unit, Istanbul, Turkey.,MedicalPark Antalya Hospital, Pediatric Bone Marrow Transplantation Unit, Antalya, Turkey
| |
Collapse
|
7
|
Phan M, Chavan R, Beuttler R, Benipayo N, Magedman G, Buchbinder D, Tomaszewski D, Yang S. Evaluating risk factors for acute graft versus host disease in pediatric hematopoietic stem cell transplant patients receiving tacrolimus. Clin Transl Sci 2021; 14:1303-1313. [PMID: 33503293 PMCID: PMC8301588 DOI: 10.1111/cts.12982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022] Open
Abstract
To identify the clinical and pharmacological risk factors associated with tacrolimus pharmacodynamics for acute graft‐versus‐host disease (aGVHD) in pediatric patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) from a matched related donor. A retrospective cohort single center chart review study was conducted with pediatric patients who received tacrolimus prophylaxis after allogeneic HSCT between January 1, 2017, and December 31, 2019. Potential risk factors were tested separately between aGVHD and non‐aGVHD cohorts and were further analyzed in a logistic regression model with backward elimination and a partial least squares discriminant analysis. Thirty‐three patient cases were included in our study and 52% (17/33) developed aGVHD while on tacrolimus prophylaxis. When tested independently, donor age and sibling versus parent donor/recipient relation were shown to be statistically significant between aGVHD and non‐aGVHD patients (p < 0.005). Pharmacological factors associated with tacrolimus treatment failed to demonstrate a significant impact on patient’s risk of aGVHD. Using a best fit logistic regression model that tested all the variables together, donor age was the only significant variable predicting patient’s risk of aGVHD (p < 0.01). Donor relationship and donor age were unable to be evaluated separately and are therefore confounding variables. Among pediatric patients receiving allogeneic HSCT, aGVHD risk is significantly decreased by either sibling donor and/or younger donors. Although no conclusions were drawn on the effect of tacrolimus therapy (p = 0.08), results warrant additional research with a larger sample size to evaluate the accuracy of monitoring tacrolimus serum trough levels.
Collapse
Affiliation(s)
- Michael Phan
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, California, USA
| | - Rishikesh Chavan
- The Hyundai Cancer Institute, CHOC Children's Hospital, Orange, California, USA
| | - Richard Beuttler
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Irvine, California, USA
| | - Nicole Benipayo
- Chapman University School of Pharmacy, Irvine, California, USA
| | - Grace Magedman
- Department of Pharmacy, CHOC Children's Hospital, Orange, California, USA
| | - David Buchbinder
- The Hyundai Cancer Institute, CHOC Children's Hospital, Orange, California, USA
| | - Daniel Tomaszewski
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Irvine, California, USA
| | - Sun Yang
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, California, USA
| |
Collapse
|
8
|
Almansoori AA, Khentii N, Ju KW, Kim B, Kim SM, Lee JH. FK506 immunosuppression for submandibular salivary gland allotransplantation in rabbit. J Korean Assoc Oral Maxillofac Surg 2020; 46:197-203. [PMID: 32606281 PMCID: PMC7338634 DOI: 10.5125/jkaoms.2020.46.3.197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 11/07/2022] Open
Abstract
Objectives We compared the outcomes of two different doses of FK506 (tacrolimus) for immunosuppression in submandibular salivary gland (SMG) allotransplantation. Materials and Methods Three SMG allotransplantation groups were established (n=6 per group) as follows: allograft rejection control (Allo-Ctrl), low dose (0.08 mg/kg) of FK506 (FK506-L), and high dose (0.16 mg/kg) of FK506 (FK506-H). Allograft survival and rejection were assessed by clinical observation, interleukin-2 levels as determined by enzyme-linked immunosorbent assay, blood sampling for complete blood count (CBC), and histological evaluation. Results Body weight and anorexia were higher in the FK506-H group but without a significant difference compared with the FK506-L population. CBC revealed a non-significantly reduced number of changes in the FK506-L group. Four glands in the FK506-H group and two glands in the FK506-L group were viable and functioning post-transplantation. Conclusion The survival rate of allotransplanted glands was higher in conjunction with the high dose of 0.16 mg/kg of FK506, with no major difference in the side-effect profile when compared with the low dose of 0.08 mg/kg short-term outcomes.
Collapse
Affiliation(s)
- Akram Abdo Almansoori
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.,Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Sana'a University, Sana'a, Yemen.,Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea.,Dental Research Institute, College of Dentistry, Seoul National University, Seoul, Korea
| | - Namuun Khentii
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kyung Won Ju
- Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea
| | - Bongju Kim
- Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea.,Dental Research Institute, College of Dentistry, Seoul National University, Seoul, Korea
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.,Dental Research Institute, College of Dentistry, Seoul National University, Seoul, Korea
| | - Jong-Ho Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.,Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea.,Dental Research Institute, College of Dentistry, Seoul National University, Seoul, Korea.,Oral Cancer Center, Seoul National University Dental Hospital, Seoul, Korea
| |
Collapse
|
9
|
Hashmi H, Bhandari S, Kumar R, Tripathi P, Rhodes JB, Figg L, Baize T, Krem MM, Hegazi M, Emmons R. Twice-daily intravenous bolus tacrolimus infusion: A safe and effective regimen for graft-versus-host disease prophylaxis. Hematol Oncol Stem Cell Ther 2020; 13:232-237. [PMID: 32413417 DOI: 10.1016/j.hemonc.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/11/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE/BACKGROUND Among patients undergoing allogeneic hematopoietic cell transplant, continuous intravenous (IV) tacrolimus infusion is frequently used for graft-versus-host disease (GvHD) prophylaxis. Twice-daily intermittent IV tacrolimus dosing may confer safety and convenience benefits. METHODS We performed a retrospective chart review of 66 patients who received twice-daily IV bolus tacrolimus for GvHD prophylaxis. The primary end point of the study was safety, as measured by renal toxicity. The secondary end points included mean tacrolimus serum concentrations, incidence of grades II-IV acute GvHD, electrolyte abnormalities, hyperglycemia, hypertension, and neurologic toxicity. RESULTS There was acceptable, possibly favorable, incidence of renal toxicity (42%) and no significant difference in grades II-IV GvHD (37%), compared with published data. Mean tacrolimus blood concentrations were not affected by occurrence of renal toxicity. CONCLUSION We conclude that administration of IV tacrolimus twice daily over 4 h may be safe and effective in preventing GvHD in allogeneic hematopoietic cell transplant.
Collapse
Affiliation(s)
- Hamza Hashmi
- Division of Hematology Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA.
| | - Shruti Bhandari
- Division of Hematology Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Rohit Kumar
- Division of Hematology Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Prashant Tripathi
- Division of Infectious Disease, University of Louisville, Louisville, KY, USA
| | - Jill Blancett Rhodes
- Division of Clinical Oncology Pharmacy, James Graham Brown Cancer Center, University of Louisville Hospital, Louisville, KY, USA
| | - Lindsay Figg
- Division of Clinical Oncology Pharmacy, James Graham Brown Cancer Center, University of Louisville Hospital, Louisville, KY, USA
| | - Timothy Baize
- Division of Clinical Oncology Pharmacy, James Graham Brown Cancer Center, University of Louisville Hospital, Louisville, KY, USA
| | - Maxwell M Krem
- Division of Hematology and Blood and Marrow Transplant, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Mohamed Hegazi
- Division of Hematology Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Robert Emmons
- Division of Hematology Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| |
Collapse
|
10
|
Bacopoulos AJ, Ho L, Yang A, Ng P, Dara C, Loach D, Deotare U, Michelis FV, Viswabandya A, Kim DD, Lipton JH, Messner HA, Thyagu S. Safety of two-hour intermittent intravenous infusions of tacrolimus in the allogeneic hematopoietic stem cell transplantation unit. J Oncol Pharm Pract 2020; 27:33-39. [PMID: 32183586 DOI: 10.1177/1078155220908948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
At our institution, tacrolimus is used as a second-line agent for the prevention and treatment of graft-versus-host-disease in the allogeneic hematopoietic stem cell transplantation (HSCT) unit after patients have experienced a serious or intolerable adverse event to cyclosporine. As per our standard practice, tacrolimus is administered via 2-h intermittent IV infusions (IIVs) every 12 h rather than continuous IV infusion. Shorter infusion times are cautioned due to concerns of higher rates of nephrotoxicity, neurotoxicity and infusion-related reactions, although there is a paucity of data to support this claim. Our primary objective was to evaluate the safety of a 2-h IIV of tacrolimus in an adult HSCT population. We retrospectively reviewed the charts of 104 patients who received tacrolimus by IIV (3574 doses; median = 22, range 1-158, IQR = 28) from 2002 to 2016. Primary outcomes collected include rates of nephrotoxicity, neurotoxicity and infusion-related reactions. One (0.9%) grade 2 infusion-related reaction occurred and resolved without discontinuation of tacrolimus. Of 16 incidences (13.6%) of nephrotoxicity, all but 10 (8.5%) cases resolved. Precipitating factors for nephrotoxicity unrelated to tacrolimus were identified in all 10 cases. There were 41 incidences (35%) of neurotoxicity, of which, 8 (6.8%) were considered serious. All neurotoxicity reverted to baseline or resolved completely. We propose that a 2-h IIV of tacrolimus is a safe method of administration in the adult HSCT setting.
Collapse
Affiliation(s)
- Alexander Js Bacopoulos
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Department of Pharmacy, University Health Network, Toronto, Canada
| | - Lina Ho
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Department of Pharmacy, University Health Network, Toronto, Canada.,Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada
| | - Anjie Yang
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Department of Pharmacy, University Health Network, Toronto, Canada
| | - Pamela Ng
- Department of Pharmacy, University Health Network, Toronto, Canada
| | - Celina Dara
- Department of Pharmacy, University Health Network, Toronto, Canada
| | - David Loach
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Uday Deotare
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Fotios V Michelis
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Auro Viswabandya
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Dennis D Kim
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jeffrey H Lipton
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hans A Messner
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Santhosh Thyagu
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
11
|
Mesenchymal Stem Cell Therapy in Submandibular Salivary Gland Allotransplantation: Experimental Study. Transplantation 2019; 103:1111-1120. [DOI: 10.1097/tp.0000000000002612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
12
|
Dheer D, Jyoti, Gupta PN, Shankar R. Tacrolimus: An updated review on delivering strategies for multifarious diseases. Eur J Pharm Sci 2018; 114:217-227. [DOI: 10.1016/j.ejps.2017.12.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/12/2017] [Accepted: 12/20/2017] [Indexed: 02/06/2023]
|
13
|
Tanaka Y, Sasaki M, Ito F, Aoyama T, Sato-Okamoto M, Takahashi-Nakaguchi A, Chibana H, Shibata N. KRE5 Suppression Induces Cell Wall Stress and Alternative ER Stress Response Required for Maintaining Cell Wall Integrity in Candida glabrata. PLoS One 2016; 11:e0161371. [PMID: 27548283 PMCID: PMC4993462 DOI: 10.1371/journal.pone.0161371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/04/2016] [Indexed: 01/10/2023] Open
Abstract
The maintenance of cell wall integrity in fungi is required for normal cell growth, division, hyphae formation, and antifungal tolerance. We observed that endoplasmic reticulum stress regulated cell wall integrity in Candida glabrata, which possesses uniquely evolved mechanisms for unfolded protein response mechanisms. Tetracycline-mediated suppression of KRE5, which encodes a predicted UDP-glucose:glycoprotein glucosyltransferase localized in the endoplasmic reticulum, significantly increased cell wall chitin content and decreased cell wall β-1,6-glucan content. KRE5 repression induced endoplasmic reticulum stress-related gene expression and MAP kinase pathway activation, including Slt2p and Hog1p phosphorylation, through the cell wall integrity signaling pathway. Moreover, the calcineurin pathway negatively regulated cell wall integrity, but not the reduction of β-1,6-glucan content. These results indicate that KRE5 is required for maintaining both endoplasmic reticulum homeostasis and cell wall integrity, and that the calcineurin pathway acts as a regulator of chitin-glucan balance in the cell wall and as an alternative mediator of endoplasmic reticulum stress in C. glabrata.
Collapse
Affiliation(s)
- Yutaka Tanaka
- Department of Infection and Host Defense, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Masato Sasaki
- Department of Infection and Host Defense, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Fumie Ito
- Department of Infection and Host Defense, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Toshio Aoyama
- Department of Electronic and Information Engineering, Suzuka National College of Technology, Suzuka, Japan
| | | | | | - Hiroji Chibana
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Nobuyuki Shibata
- Department of Infection and Host Defense, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- * E-mail:
| |
Collapse
|
14
|
Bauters T, Rayner P, Therrien R, Van Lancker S, Bordon V, Le Cordroch M, Dhooge C, Benoit Y, Vandenbroucke J. Practical considerations in the use of intravenous tacrolimus in hematopoietic stem cell transplantation patients. J Oncol Pharm Pract 2014; 21:478-80. [PMID: 24748582 DOI: 10.1177/1078155214531609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tiene Bauters
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
| | - Patricia Rayner
- Department of Pharmacy, Children's Hospital Michigan, Detroit, MI, USA
| | - Roxane Therrien
- Department of Pharmacy, CHU Sainte-Justine, Montreal, Canada
| | - Sophie Van Lancker
- Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Victoria Bordon
- Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | | | - Catharina Dhooge
- Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Yves Benoit
- Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | | |
Collapse
|