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Garcia CR, Myint ZW, Jayswal R, Wang C, Morgan RM, Butts AR, Weiss HL, Villano JL. Hematological adverse events in the management of glioblastoma. J Neurooncol 2022; 156:153-161. [PMID: 34820776 PMCID: PMC8829911 DOI: 10.1007/s11060-021-03891-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/30/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hematological adverse events (HAEs) are common during treatment for glioblastoma (GBM), usually associated with temozolomide (TMZ). Their clinical value is uncertain, as few investigations have focused on outcomes for HAEs during GBM treatment. METHODS We combined data from two randomized clinical trials, RTOG 0525 and RTOG 0825, to analyze HAEs during treatment for GBM. We investigated differences between chemoradiation and adjuvant therapy, and by regimen received during adjuvant treatment. RESULTS 1454 patients participated in these trials, of which 1154 (79.4%) developed HAEs. During chemoradiation, 44.4% of patients developed HAEs (54% involving more than one cell line), and were most commonly lymphopenia (50.6%), and thrombocytopenia (47.5%). During adjuvant treatment, 45% of patients presented HAEs (78.6% involving more than one cell line), and were more commonly leukopenia (62.7%), and thrombocytopenia (62.3%). Median overall survival (OS) and progression free survival (PFS) were longer in patients with HAEs (OS 19.4 months and PFS 9.9 months) compared to those with other or no adverse events (OS 14.1 months and PFS 5.9 months). There was no significant difference in survival between grade 1 and/or 2 versus grade 3 and/or 4 HAEs. History of HAEs during chemoradiation was a protective factor for presentation of HAEs during adjuvant therapy. CONCLUSION HAEs are common during GBM treatment, and often involve more than one cell line (more likely during adjuvant therapy). HAEs may be associated with prolonged OS and PFS, particularly during adjuvant therapy. HAEs during chemoradiation was a protective factor for HAEs during adjuvant therapy.
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Affiliation(s)
| | - Zin W. Myint
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.,Division of Medical Oncology, University of Kentucky, Lexington, KY, USA
| | - Rani Jayswal
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.,Division of Medical Oncology, University of Kentucky, Lexington, KY, USA
| | - Chi Wang
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.,Division of Cancer Biostatistics, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Rachael M. Morgan
- Department of Pharmacy Services, University of Kentucky, Lexington, KY, USA
| | - Allison R. Butts
- Department of Pharmacy Services, University of Kentucky, Lexington, KY, USA
| | - Heidi L. Weiss
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - John L. Villano
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.,Division of Medical Oncology, University of Kentucky, Lexington, KY, USA.,Department of Neurology, University of Kentucky, Lexington, KY, USA.,Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
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Corallo CE, Coutsouvelis J, Morgan S, Morrissey O, Avery S. Dapsone for Pneumocystis jirovecii pneumonia prophylaxis - applying theory to clinical practice with a focus on drug interactions. Drug Metab Pers Ther 2020; 35:dmpt-2019-0018. [PMID: 32681773 DOI: 10.1515/dmpt-2019-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 05/14/2020] [Indexed: 11/15/2022]
Abstract
Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised individuals. The incidence can be as high as 80% in some groups but can be reduced to less than 1% with appropriate prophylaxis. HIV-infected patients with a low CD4 count are at the highest risk of PJP. Others at substantial risk include haematopoietic stem cell and solid organ transplant recipients, those with cancer (particularly haematologic malignancies), and those receiving glucocorticoids, chemotherapeutic agents, and other immunosuppressive medications. Trimethoprim-sulfamethoxazole is an established first-line line agent for prevention and treatment of PJP. However, in some situations, this medication cannot be used and dapsone is considered a suitable cost-effective second line agent. However, information on potential interactions with drugs commonly used in immunosuppressed patients is lacking or contradictory. In this this article we review the metabolic pathway of dapsone with a focus on interactions and clinical significance particularly in patients with haematological malignancies. An understanding of this process should optimise the use of this agent.
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Affiliation(s)
| | | | - Susan Morgan
- Alfred Health, Haematology, Melbourne, Victoria, Australia
| | - Orla Morrissey
- Alfred Health, Infectious Diseases, Melbourne, Victoria, Australia
| | - Sharon Avery
- Alfred Health, Haematology, Melbourne, Victoria, Australia
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3
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Rogers LR, Oppelt P, Nayak L. Hemolytic anemia associated with dapsone PCP prophylaxis in GBM patients with normal G6PD activity. Neuro Oncol 2020; 22:892-893. [DOI: 10.1093/neuonc/noaa026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lisa R Rogers
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Peter Oppelt
- Washington University, St Louis Siteman Cancer Center, St Peters, Missouri
| | - Lalitha Nayak
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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4
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Ghaoui N, Hanna E, Abbas O, Kibbi AG, Kurban M. Update on the use of dapsone in dermatology. Int J Dermatol 2020; 59:787-795. [PMID: 31909480 DOI: 10.1111/ijd.14761] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/22/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022]
Abstract
Dapsone (4,4'-diaminodiphenylsulfone) is the only remaining sulfone used in anthropoid therapeutics and is commercially available as an oral formulation, an inhaled preparation, and a 5% or 7.5% cream. Dapsone has antimicrobial effects stemming from its sulfonamide-like ability to inhibit the synthesis of dihydrofolic acid. It also has anti-inflammatory properties such as inhibiting the production of reactive oxygen species, reducing the effect of eosinophil peroxidase on mast cells and down-regulating neutrophil-mediated inflammatory responses. This allows for its use in the treatment of a wide variety of inflammatory and infectious skin conditions. Currently in dermatology, the US Food and Drug Administration (FDA)-approved indications for dapsone are leprosy, dermatitis herpetiformis, and acne vulgaris. However, it proved itself as an adjunctive therapeutic agent to many other skin disorders. In this review, we discuss existing evidence on the mechanisms of action of dapsone, its FDA-approved indications, off-label uses, and side effects.
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Affiliation(s)
- Nohra Ghaoui
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Edith Hanna
- Department of Dermatology, University of Toronto, Toronto, ON, Canada
| | - Ossama Abbas
- Department of Dermatology, American University of Beirut, Beirut, Lebanon
| | - Abdul-Ghani Kibbi
- Department of Dermatology, American University of Beirut, Beirut, Lebanon
| | - Mazen Kurban
- Department of Dermatology, American University of Beirut, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
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5
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Corallo C, Coutsouvelis J, Avery S, Morgan S, Morrissey O. Dapsone and azole interactions: A clinical perspective. J Oncol Pharm Pract 2017; 24:637-640. [DOI: 10.1177/1078155217722048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An understanding of the clinical significance of dapsone-drug interactions is essential for optimal use of this agent. This review aims to provide clinicians with an overview of this topic.
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Affiliation(s)
| | | | - Sharon Avery
- Pharmacy Department, Alfred Hospital, Victoria, Australia
| | - Susan Morgan
- Pharmacy Department, Alfred Hospital, Victoria, Australia
| | - Orla Morrissey
- Pharmacy Department, Alfred Hospital, Victoria, Australia
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6
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Murphy AG, Grossman SA. Acute hemolysis in a patient with a newly diagnosed glioblastoma. CNS Oncol 2016; 5:125-9. [PMID: 27230975 DOI: 10.2217/cns-2015-0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We describe a 62-year-old of Egyptian origin who presented with sudden, severe and symptomatic anemia requiring hospitalization shortly after beginning concurrent radiation and temozolomide for his newly diagnosed glioblastoma. He had also recently been started on steroids, anticonvulsants and Pneumocystis jirovecii prophylaxis. He was ultimately diagnosed with G6PD deficiency with an acute hemolytic anemia precipitated by dapsone. Screening for G6PD deficiency should be considered in high-risk patient populations where P. jirovecii prophylaxis is planned.
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Affiliation(s)
- Adrian G Murphy
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Stuart A Grossman
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
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