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Tran M, Palmer S, Moore DT, Bartelt L, Friedland A, Grgic T, Lachiewicz A, Ptachcinski J, Sena A, Trepte M, van Duin D, Andermann TM, Shaw R. Utility of Urine Cultures During Febrile Neutropenia Workup in Hematopoietic Stem Cell Transplantation Recipients Without Urinary Symptoms. Open Forum Infect Dis 2023; 10:ofad236. [PMID: 37265665 PMCID: PMC10230562 DOI: 10.1093/ofid/ofad236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
The utility of obtaining screening urine cultures for febrile neutropenia (FN) during hematopoietic stem cell transplant (HCT) is unknown. In 667 adult HCT patients with FN, only 40 (6%) were found with bacteriuria. Antibiotics were modified in 3 patients (0.4%) based on urine cultures and none developed urinary-associated infectious complications.
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Affiliation(s)
- Mya Tran
- Department of Pharmacy, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
| | - Shannon Palmer
- Department of Pharmacy, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Dominic T Moore
- Department of Biostatistics, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Luther Bartelt
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Anne Friedland
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Tatjana Grgic
- Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Anne Lachiewicz
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Jon Ptachcinski
- Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Arlene Sena
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Morgan Trepte
- Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - David van Duin
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Tessa M Andermann
- Correspondence: Tessa Andermann, MD, MPH, University of North Carolina at Chapel Hill, 111 Mason Farm Road, cb# 7036, Chapel Hill, NC, 27599-7036 (); Ryan Shaw, PharmD, BCPS, BCOP, University of North Carolina at Chapel Hill, 101 Manning Dr., Chapel Hill, NC, 27599
| | - Ryan Shaw
- Correspondence: Tessa Andermann, MD, MPH, University of North Carolina at Chapel Hill, 111 Mason Farm Road, cb# 7036, Chapel Hill, NC, 27599-7036 (); Ryan Shaw, PharmD, BCPS, BCOP, University of North Carolina at Chapel Hill, 101 Manning Dr., Chapel Hill, NC, 27599
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Shuman K, Palmer S, Anders B, Moore D, Ptachcinski J, Grgic T, Alexander M, Hill L, Sung AD, Armistead PM, Kennedy L, Shaw JR. Correlation of Engraftment and Time from Melphalan Administration to Stem Cell Infusion. Transplant Cell Ther 2023; 29:36.e1-36.e5. [PMID: 36404519 DOI: 10.1016/j.jtct.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
Single-agent, high-dose melphalan continues to be the most commonly used conditioning regimen for transplantation-eligible patients with multiple myeloma undergoing autologous stem cell transplantation. The timing of melphalan administration with respect to stem cell infusion has not been clearly defined. Many institutions require a minimum of 24 hours between melphalan administration and stem cell infusion; however, some institutions have adopted shorter intervals based on melphalan's short half-life. Some studies have suggested that shortening the interval between melphalan administration and stem cell infusion may contribute to delays in engraftment, but this correlation has not been clearly evaluated or defined. This multicenter retrospective cohort study evaluated the times to neutrophil and platelet engraftment in patients who received stem cells at least 24 hours after melphalan (≥24 hours cohort) compared with those who received stem cells within 24 hours of melphalan (<24 hours cohort. The study included a total of 723 adult patients, 502 patients in the ≥24 hours cohort and 221 in the <24 hours cohort, treated at 3 transplantation centers between January 1, 2016, and September 30, 2019. Patient characteristics were summarized using descriptive statistics. The Fisher exact test was used to compare nominal categorical variables between the 2 cohorts, and the nonparametric van der Waerden test or Mood median test was used to compare ordinal or continuous variables. The median time to neutrophil engraftment was 12 days for both the ≥24 hours cohort (interquartile range [IQR], 11 to 12 days) and the <24 hours cohort (IQR, 11 to 13 days) (P = .07). The median time to platelet engraftment was 19 days for both the ≥24 hours cohort (IQR, 17 to 22 days) and <24 hours cohort (IQR, 17 to 20 days) (P = .25). The median time between melphalan administration and stem cell infusion in the <24 hours cohort was 18 hours, with a minimum time of 12 hours. The existing literature has not clearly defined the impact of the timing between melphalan administration and stem cell infusion on engraftment in autologous transplantation. The ability to safely shorten the interval between chemotherapy and transplantation could increase logistical flexibility and/or decrease the length of hospital stay. This large multicenter retrospective study did not identify a statistical or clinical impact on engraftment when melphalan was infused <24 hours or ≥24 hours before autologous stem cell infusion.
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Affiliation(s)
- Kaci Shuman
- Huntsville Hospital, Department of Pharmacy, Huntsville, Alabama
| | - Shannon Palmer
- Oregon Health & Science University, Department of Pharmacy, Portland, Oregon
| | - Brandi Anders
- Atrium Health Wake Forest Baptist, Department of Pharmacy, Winston-Salem, North Carolina
| | - Dominic Moore
- University of North Carolina Health, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Jonathan Ptachcinski
- University of North Carolina Health, Department of Pharmacy, Chapel Hill, North Carolina
| | - Tatjana Grgic
- University of North Carolina Health, Department of Pharmacy, Chapel Hill, North Carolina
| | - Maurice Alexander
- University of North Carolina Health, Department of Pharmacy, Chapel Hill, North Carolina
| | - Lauren Hill
- Duke University Health System, Division of Hematologic Malignancies and Cellular Therapy, Durham, North Carolina
| | - Anthony D Sung
- Duke University Health System, Division of Hematologic Malignancies and Cellular Therapy, Durham, North Carolina
| | - Paul M Armistead
- University of North Carolina Health, Division of Hematology; Program in Bone Marrow Transplant and Cellular Therapy, Chapel Hill, North Carolina
| | - LeAnne Kennedy
- Atrium Health Wake Forest Baptist, Department of Pharmacy, Winston-Salem, North Carolina
| | - J Ryan Shaw
- University of North Carolina Health, Department of Pharmacy, Chapel Hill, North Carolina.
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Chen KY, Bucci TG, Shaw JR, Alexander MD, Grgic T, Riches M, Ptachcinski JR. Plerixafor strategies for autologous hematopoietic cell transplant mobilization: A comparison of efficacy and cost. Transfus Apher Sci 2021; 61:103303. [PMID: 34801430 DOI: 10.1016/j.transci.2021.103303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/15/2022]
Abstract
Addition of plerixafor (P) to granulocyte colony stimulating factor (G-CSF) during peripheral blood mobilization of hematopoietic stem cells (HSC) increases the number of patients meeting collection goals prior to autologous stem cell transplant (aSCT). However, use of P is not universal among transplant centers due to cost. This study aims to compare clinical and financial impacts of using an algorithm-based P mobilization strategy versus use in all patients. This was a single center, retrospective analysis of adult patients with myeloma or amyloidosis receiving aSCT who received apheresis of their HSC between 3/1/2017 and 3/1/2019. Patients prior to 3/1/2018 were classified as receiving P "per algorithm" and those after this date were classified as "up-front" P. For the per-algorithm group, P was given for a pre-apheresis CD34+ cell count of <20 cells/μL on mobilization day 5 and patients returned on day 6 for apheresis. Of the 129 patients included, 55 received P per-algorithm and 74 received up-front P. There was a reduction in median number of apheresis days (1.5 vs 1 day, p < 0.001) and an increase in median number of CD34+ cells collected (6.6 vs 8.5 × 106 cells/kg, p < 0.001) with up-front P. Up-front P increased drug cost but reduced apheresis costs, which resulted in a net savings of $121 per patient in total mobilization costs. These findings suggest that use of up-front P for mobilization significantly reduces apheresis days and increases HSC collection yield without increasing overall cost per patient.
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Affiliation(s)
- Kevin Y Chen
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, United States; UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States
| | - Tyler G Bucci
- University of Washington Medical Center, Seattle, WA, United States
| | - J Ryan Shaw
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, United States; UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States
| | - Maurice D Alexander
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, United States; UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States
| | - Tatjana Grgic
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, United States; UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States
| | - Marcie Riches
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States
| | - Jonathan R Ptachcinski
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, United States; UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States.
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Shuman K, Palmer S, Anders B, Armistead PM, Moore DT, Ptachcinski J, Grgic T, Alexander M, Bohannon L, Sung AD, Shaw JR, Kennedy L. Correlation of Engraftment and Time from Melphalan Administration to Stem Cell Infusion. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dennison T, Pedretti Z, Stocker K, Alexander M, Shaw JR, Grgic T, Ptachcinski J. Comparison of Cyclophosphamide- Versus Etoposide-Based Chemomobilization for Autologous Stem Cell Transplant in Lymphoma. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stump SE, Trepte M, Shaw JR, Grgic T, Ptachcinski JR, Sharf A, Riches M, Shea TC, Park YA, Alexander MD. Evaluation of mobilization efficacy with an extended interval following plerixafor administration. J Oncol Pharm Pract 2020; 26:1590-1597. [PMID: 32063103 DOI: 10.1177/1078155219900909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Plerixafor is a hematopoietic stem cell mobilizing agent used in combination with granulocyte-colony stimulating factor to improve collection for autologous stem cell transplantation. Despite a recommendation for administration 11 h prior to apheresis per package labeling, logistical challenges lead many institutions to administer plerixafor at an extended interval. The purpose of this study was to determine if plerixafor effectively and efficiently mobilizes CD34+ cells when given at an extended interval prior to apheresis. This was a retrospective evaluation of adult patients who received plerixafor based on an algorithm reserving daily plerixafor only for patients with a pre-apheresis CD34+ count of < 20 cells/µL (pre-apheresis plerixafor) or with a low CD34+ yield after the first apheresis session (rescue plerixafor). The primary outcome was achievement of a disease-specific collection goal of ≥ 6 ×106 CD34+ cells/kg for multiple myeloma and ≥ 4 ×106 CD34+ cells/kg for lymphoma. The mean interval between plerixafor administration and apheresis was 17 h in this study. Despite this extended interval, 64% of patients met their disease-specific collection goal. A minimum collection goal of ≥ 2 ×106 CD34+ cells/kg was achieved by 95% of patients. Mobilization remained efficient with a median of two days to complete collection. Based on this data, plerixafor effectively and efficiently mobilizes CD34+ cells when given at an extended interval prior to apheresis.
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Affiliation(s)
- Sarah E Stump
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Morgan Trepte
- Department of Pharmacy, Northside Hospital, Atlanta, GA, USA
| | - J Ryan Shaw
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Tatjana Grgic
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Jonathan R Ptachcinski
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Andrew Sharf
- Bone Marrow Transplant and Cellular Therapy Program, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Marcie Riches
- Bone Marrow Transplant and Cellular Therapy Program, University of North Carolina Medical Center, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Thomas C Shea
- Bone Marrow Transplant and Cellular Therapy Program, University of North Carolina Medical Center, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Yara A Park
- Department of Pathology and Laboratory Medicine, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Maurice D Alexander
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
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Cunningham HE, Shea TC, Grgic T, Lachiewicz AM. Successful treatment of hepatitis C virus infection with direct‐acting antivirals during hematopoietic cell transplant. Transpl Infect Dis 2019; 21:e13091. [DOI: 10.1111/tid.13091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/20/2019] [Accepted: 04/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Thomas C. Shea
- University of North Carolina Bone Marrow Transplant and Cellular Therapy Program Chapel Hill North Carolina
- University of North Carolina Lineberger Comprehensive Cancer Center Chapel Hill North Carolina
| | - Tatjana Grgic
- Department of Pharmacy University of North Carolina Medical Center Chapel Hill North Carolina
| | - Anne M. Lachiewicz
- Division of Infectious Diseases University of North Carolina North Carolina
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Crandell BC, Bates JS, Grgic T. Start using a checklist, PRONTO: Recommendation for a standard review process for chemotherapy orders. J Oncol Pharm Pract 2017; 24:609-616. [DOI: 10.1177/1078155217722594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chemotherapy order review by pharmacists requires careful attention to many details, and serious consequences can occur if errors are made. Other high-risk industries have long used checklists to improve accuracy and reduce the risk of errors. Despite the recent expansion of checklist use in other areas of medicine, there is currently no published evidence that checklists are being widely used by pharmacists in the evaluation of chemotherapy orders. This article explains a flexible checklist called PRONTO (Patient, Regimen, Organ Function, Numbers, Toxicity, Order Verification) that has been successfully used by pharmacists in variety of practice settings in two academic centers in North Carolina. Proposed benefits of using a checklist in order review include standardization of review for better communication between collaborating pharmacists, a training tool for new or cross-training pharmacists, and an educational tool for students.
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Affiliation(s)
- Brian C Crandell
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
- Eschelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Jill S Bates
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
- Eschelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Tatjana Grgic
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
- Eschelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
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Cikes M, Skoric B, Pasalic M, Gasparovic H, Caleta T, Forgac J, Grgic T, Baricevic Z, Lovric D, Ivancan V, Biocina B, Milicic D. The Change in Pulmonary Vascular Resistance After LVAD Implantation - Can It Aid in Predicting Postimplantation Survival? J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Grgic T, Mis L, Hammond JM. Everolimus: a new mammalian target of rapamycin inhibitor for the treatment of advanced renal cell carcinoma. Ann Pharmacother 2010; 45:78-83. [PMID: 21177421 DOI: 10.1345/aph.1m288] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review clinical trials and main characteristics of everolimus, with focus on treatment of advanced renal cell carcinoma. DATA SOURCES Pertinent data were identified primarily through a search of MEDLINE and PubMed (1966-November 2010) using the primary search terms everolimus, RAD001, renal cell carcinoma, and mTOR inhibitors. STUDY SELECTION AND DATA EXTRACTION Studies evaluating the safety and efficacy of everolimus in patients with cancer were evaluated, including Phase 1, 2, and 3 trials. Preference was given to Phase 2 and 3 studies evaluating use of everolimus in patients with renal cell carcinoma. DATA SYNTHESIS Everolimus is an oral mammalian target of rapamycin (mTOR) inhibitor approved for the management of patients with advanced renal cell carcinoma who progressed on tyrosine kinase inhibitor therapy. Actions of everolimus within the mTOR pathway result in decreased protein synthesis and cell cycle arrest, as well as decreased angiogenesis. A usual starting dose for patients with renal cell carcinoma is 10 mg daily. Everolimus undergoes extensive hepatic metabolism, primarily through the CYP3A4 isoenzyme, which predisposes it to drug interactions with inducers and inhibitors of this enzyme. Most commonly reported adverse events associated with everolimus include anemia, hyperglycemia, hypercholesterolemia, mucositis, fatigue, and rash. Approval of everolimus was based on the results of a Phase 3 trial that demonstrated an increase in median progression-free survival by 2.1 months in patients receiving everolimus therapy as compared to placebo. The drug was recently added to the National Comprehensive Cancer Network guidelines as a treatment option for patients with advanced renal cell carcinoma who have progressed on tyrosine kinase therapy. CONCLUSIONS Based on a review of the currently available literature, everolimus provides a safe and efficacious treatment option for patients with renal cell carcinoma who have progressed on treatment with sunitinib and/or sorafenib.
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Affiliation(s)
- Tatjana Grgic
- Department of Pharmacy, Duke University Medical Center, Durham, NC, USA.
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