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Potential drug–drug interactions and nephrotoxicity in hematopoietic stem cell transplant adult recipients during bone marrow transplantation unit stay

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Abstract

Purpose

Studies have documented potential drug–drug interactions (pDDIs) occurring in cancer patients mainly with solid malignancies, either in the ambulatory or hospital settings. While hematopoietic stem cell transplant (HSCT) patients during their bone marrow transplantation unit (BMTU) stay have rather complex medical regimens combining chemotherapy, anti-infectious agents, immunosuppressive agents, and supportive-care drugs, studies on potential DDIs are lacking. Our objective was to evaluate the prevalence and the density of pharmacokinetic and pharmacodynamic potential DDIs, and the evolution of the renal function in hematopoietic stem cell transplant (HSCT) adult recipients during their BMTU stay.

Methods

Retrospective study in 31 adult patients consecutively admitted to the BMTU.

Results

Prevalence of pharmacokinetic interactions was ten times lower than the pharmacodynamic interactions. The contraindications were rare, and only of pharmacokinetic origin. The main drugs involved in pharmacokinetic DDIs were ciclosporine, methotrexate, esomeprazole, tramadol, and vincristine. The median number of potential nephrotoxicity-related DDIs per patient was 7 and the median number of days during which nephrotoxicity-related DDIs potentially occurred was 77 days per patient. The decrease in glomerular filtration rate (GFR) throughout the BMTU stay (mean decrease of 13 ml/min) was correlated with the number of days of potential nephrotoxic drug interactions.

Conclusions

Potential DDIs in HCST patients in BMTU were quite common. The DDIs from pharmacokinetic origin were less frequent, but of higher grade, than those of pharmacodynamic origin. The decrease in GFR suggests that the density of potential nephrotoxic drug interactions may be an issue to be considered in these patients.

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Authors and Affiliations

  1. Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033, Rennes, France

    Lydia Sanchez, Astrid Bacle & Pascal Le Corre

  2. Pharmacia Del Carre López, 48012, Bilbao, Spain

    Lydia Sanchez

  3. Pôle Médecines Spécialisées, Service d’Hématologie Clinique, CHU de Rennes, 35033, Rennes, France

    Thierry Lamy

  4. Univ Rennes 1, INSERM, EFS Bretagne, UMR U1236, 35033, Rennes, France

    Thierry Lamy

  5. Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043, Rennes Cedex, France

    Astrid Bacle & Pascal Le Corre

  6. Univ Rennes, CHU Rennes, Inserm, EHESP, Irset-UMR_S 1085, 35000, Rennes, France

    Astrid Bacle & Pascal Le Corre

Authors
  1. Lydia Sanchez
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  2. Astrid Bacle
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  4. Pascal Le Corre
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Correspondence to Pascal Le Corre.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Institutional Ethical committee of our institution with a waiver of patient consent authorization (No. 18.76). Since the design of the study is retrospective, no formal consent is required.

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Sanchez, L., Bacle, A., Lamy, T. et al. Potential drug–drug interactions and nephrotoxicity in hematopoietic stem cell transplant adult recipients during bone marrow transplantation unit stay. Cancer Chemother Pharmacol 83, 827–835 (2019). https://doi.org/10.1007/s00280-019-03791-9

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  • DOI: https://doi.org/10.1007/s00280-019-03791-9

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