Supportive care medications coinciding with chemotherapy among children with hematologic malignancy

Abstract

Pharmacokinetic (PK) conflicts can arise between supportive care medications (SCM) and chemotherapy in children with hematologic malignancy (HM). In this retrospective study, medical records for children (28 days–18 years) diagnosed with HM and receiving an SCM antimicrobial were collected from a hospital network between 1 May 2000 and 31 December 2014. PK drug–gene associations were obtained from a curated pharmacogenomics database. Among 730 patients (median age of 7.5 (IQR 3.7–13.9) years), primarily diagnosed with lymphoid leukemia (52%), lymphoma (28%), or acute myeloid leukemia (16%), chemotherapy was administered in 2846 hospitalizations. SCM accounted for 90.5% (n = 448) of distinct drugs with 93% (n = 679) of children, receiving ≥5 different SCM/hospitalization. Same-day SCM/chemotherapeutic PK gene overlap occurred in 48.3% of hospitalizations and was associated with age (p = 0.026), number of SCM, HM subtype, surgery, and hematopoietic stem cell transplant (p < 0.0001). A high and variable SCM burden among children with HM receiving chemotherapy poses a risk for unanticipated PK conflicts.

Keywords:

• Polypharmacy
• pediatric
• cancer
• pharmacokinetic
• pharmacogenomic
• drug interactions

Acknowledgments

The authors thank Dr. Michelle Whirl-Carrillo for guidance on PharmGKB data. Kent Korgenski, MT, MS provided helpful discussions as well as the data extraction from IH.

Disclosure statement

All contributing authors declare no conflicts of interest.

Data availability statement

The data that support the findings of this study are available from PHIS and IH but restrictions apply to the availability of these data, which were used under Institutional Review Board protocols for the current study, and so are not publicly available.

Additional information

Funding

The Primary Children’s Hospital Cancer Project and an Early Career Development Research Award (JEC) from the Primary Children’s Hospital Foundation helped to support this project. Additionally, JEC received support from the National Institutes of Health, National Cancer Institute, Loan Repayment Program: Pediatric Research, under award number L40CA220948-01.