Pharmacists Present Their Research at the 2016 American Society of Hematology Meeting
The 58th Annual American Society of Hematology (ASH) Meeting and Exposition was held December 3–6, 2016, in San Diego, CA. HOPA members Justina Frimpong, Alex Ganetsky, Lauren Levine, Jigar Trivedi, and Tracy Wiczer presented their research. Summaries of their abstracts are provided here.
Justina Frimpong, PharmD BCOP
Dr. Frimpong presented “Impact of Obesity in Patients with Multiple Myeloma Receiving High- Dose Melphalan Followed by Autologous Hematopoietic Cell Transplantation.” In this retrospective cohort study, outcomes and toxicities of high-dose melphalan followed by autologous hematopoietic cell transplantation (HCT) were evaluated in a total of 462 nonobese (body mass index [BMI] <30 kg/m2), obese (BMI 30–34.9 kg/m2), and severely obese (BMI ≥35 kg/m2) multiple myeloma patients. All three cohorts had similar baseline characteristics except for age ≤65 years and the use of adjusted body weight for melphalan dosing (nonobese, 4.5%; obese, 25.7%; severely obese, 41.2%; p < .001). Across all three cohorts, no significant differences were seen in the primary end points of nonrelapse mortality (NRM) and overall survival (OS). Durie-Salmon Stage (DSS) 3 was the only independent predictor of inferior OS, and in a multivariate analysis, actual-weight dosing was associated with a decreased risk of NRM (p = .003). In patients receiving actual-weight dosing of melphalan, febrile neutropenia was more common in nonobese patients compared with obese and severely obese patients (71.4% vs. 56.4% and 62.5%, respectively; p = .03). The authors concluded that administration of high-dose melphalan and autologous HCT can be performed safely in obese myeloma patients, but further research is needed to evaluate the effect of dose adjustments on outcomes. To read the full abstract for Dr. Frimpong’s research, visit https://ash.confex.com/ash/2016/webprogram/Paper90208.html.
Alex Ganetsky, PharmD BCOP
Dr. Ganetsky presented two posters at the meeting. In the poster titled “Tocilizumab Is Highly Active for Severe Steroid-Refractory Acute Graft-Versus-Host Disease of the Gastrointestinal Tract,” Dr. Ganetsky provided retrospective data evaluating the efficacy of tocilizumab, an interleukin-6 receptor antagonist, for the treat- ment of severe steroid-refractory gastrointestinal graft-versus-host disease (GI-GVHD). Five patients with grade 4 steroid refractory, biopsy-proven GVHD received intravenous tocilizumab 8 mg/kg every 2 weeks until achievement of a complete response (CR). After a median time of 9 days, all five patients (100%) achieved a CR. Two patients achieved a CR after 1 tocilizumab dose, and three patients required 2–4 doses. Serum levels of pro-inflammatory cytokines were measured, but no association was seen between cytokine levels and response to tocilizumab. To read the full abstract for Dr. Ganetsky’s research, visit .
The second poster presented by Dr. Ganetsky was “Oral Vancomycin Is Highly Effective in Preventing Clostridium Difficile Infection in Allogeneic Hematopoietic Stem Cell Transplant Recip- ients.” Clostridium difficile infection (CDI) is a common infectious complication in allogeneic hematopoietic stem cell transplantation (alloHCT). Dr. Ganetsky conducted a retrospective study evaluat- ing the effectiveness of oral vancomycin 125 mg twice daily versus no prophylaxis in 105 adult patients undergoing alloHCT. During the inpatient admission for alloHCT, no cases of CDI were reported in the oral vancomycin prophylaxis group (0/50; 0%) compared with 11/55 (20%) of patients in the no-prophylaxis group. No cases of vancomycin-resistant enterococcus bloodstream infections were reported in patients who received vancomycin prophylaxis. The au- thors concluded that prophylactic vancomycin is highly effective in preventing CDI in alloHCT recipients but acknowledged that longer follow-up is needed. To read the full abstract for Dr. Ganetsky’s research, visit https://ash.confex.com/ash/2016/webprogram/Paper93290.html.
Jigar Trivedi, PharmD MSc
Dr. Trivedi presented two posters at the meeting. One poster, “Optimizing Progenitor Cell Mobilization in Patients with Myeloma: Effect of a Pre-Emptive Day 4 Plerixafor- Based Mobilization Algorithm,” provides an algorithm for using pre-emptive day 4 plerixafor to maximize collection-day peripheral blood (PB) CD34+ cell numbers in patients undergoing peripheral blood progenitor cell (PBPC) mobilization. Data from 105 patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation (AHSCT) were analyzed retrospectively. On day 4, patients with PBCD34+ <50 cells/μL (90% of patients studied) received either one subcutaneous dose of plerixafor 0.24 mg/kg or a 12-mg fixed dose. The fixed dose was administered to patients who could be paired with another patient who was simultaneously undergoing PBPC mobilization. No significant difference was seen in the collection yield (median 10.95 million CD34+ cells/ kg) of the two dosing groups. Optimal mobilization occurred in 96.2% of patients and was achieved with only 1 day of collection in 94.2% of patients. The authors concluded that pre-emptive use of day 4 plerixafor is effective and results in a high percentage of optimal day 1 collections, which demonstrated the utility of the plerixafor-based mobilization algorithm. To read the full abstract for Dr. Trivedi’s research, visit https://ash.confex.com/ash/2016/webprogram/Paper97191.html.
The second poster presented by Dr. Trivedi was “CYP2C19 Genotype-Guided Dosing and Voriconazole Concentrations in Hematopoietic Stem Cell Transplant (HSCT) Patients Receiving Antifungal Prophylaxis.” Voriconazole is an azole antifungal agent metabolized via CYP2C19. Drs. Patel, Trivedi, and colleagues performed the first prospective clinical study investigating the impact of CYP2C19 genotype-guided voriconazole dosing on trough concentrations and clinical outcomes in adult allogenic HSCT patients. Patients harboring the *1/*1 (rapid metabolizers [RMs]) or *17/*17 (ultra-rapid metabolizers [UMs]) genotypes received oral voriconazole 300 mg twice daily post-transplant, whereas the standard 200 mg twice-daily dose was administered to all other patients. Data for 26 patients was available at the time of interim analysis, and of these patients, 8% were UMs, 23% RMs, 46% normal, 19% intermediate, and 4% poor metabolizers. This voriconazole dosing strategy reduced the percentage of patients with subtherapeutic levels at days 5–7 from historically 50% to 30.8% (p = .038). No RMs or UMs were at subtherapeutic levels, compared with 80% in historical controls (p < .001). In addition, no supratherapeutic trough concentrations or grade 3/4 drug-related adverse events were observed. To read the full abstract for Dr. Trivedi’s research, visit https://ash.confex.com/ash/2016/ webprogram/Paper94963.html.
Tracy Wiczer, PharmD BCOP, and Lauren Levine, PharmD BCOP
Drs. Wiczer and Levine presented “Management and Outcomes of Atrial Fibrillation in Patients Receiving Ibrutinib for Hematologic Malignancies at a Single Center.” Ibrutinib, an oral Bruton’s tyrosine kinase inhibitor, has been associated with a 2%–16% reported incidence of atrial fibrillation (a-fib). An increased bleeding risk has also been associated with ibrutinib, which may be exacerbated by anticoagulation and antiplatelet therapy. To provide data for this clinical quandary, Wiczer and Levine performed a retrospective analysis in which they identified 72 patients with incident or recurrent a-fib while taking ibrutinib. The majority of the a-fib events were grade 1 or 2 (93%); 7% were grade 3. First-line therapy included rate-control (75%), interventional procedural strategies (11.1%), rhythm control (4.2%), or no intervention (9.7%). A major bleeding event occurred in six patients (8.3%), and two of these patients had a second major bleed. Of these eight major bleeding events, three occurred while the patient was on antiplatelet agents, and none occurred while the patient was on anticoagulation. In addition, 25% of patients experienced a nonmajor bleeding event. The authors concluded that patients experiencing an a-fib event while on ibrutinib could be easily managed, but the optimal strategy for stroke prophylaxis in this patient population is unclear. To read the full abstract for Wiczer and Levine’s research, visit https://ash.confex.com/ash/2016/webprogram/Paper92564.html.