ERİŞKİN KEMİK İLİĞİ TRANSPLANTASYON ÜNİTESİNDE POTANSİYEL İLAÇ ETKİLEŞİMLERİNİN BELİRLENMESİ -PROSPEKTİF ÇALIŞMA

Öz

Amaç: Kemik iliği nakli öncesi ve sonrasında yaşanan komplikasyonlar, uzun ve zorlu tedavi sürecinin ile çoklu ilaç kullanımı, ilaç-ilaç etkileşimlerine yol açabilmektedir. Çalışmamızın amacı, erişkin kemik iliği transplantasyon ünitesinde yatan hastalarda potansiyel ilaç etkileşimlerini değerlendirmektir. Gereç ve Yöntem: Bu çalışma, Türkiye'de özel bir hastanenin erişkin kemik BMT ünitesinde Ocak-Haziran 2021 tarihleri arasında yapılmış prospektif ve tanımlayıcı bir çalışmadır. Hastaların sosyodemografik özellikleri kaydedilmiştir. Potansiyel ilaç etkileşimleri, Medscape ve Lexicomp ilaç etkileşimi veritabanları kullanılarak analiz edilmiştir. Analiz için SPSS 15 kullanılmıştır. Sonuç ve Tartışma: Çalışmaya dahil edilen 40 hastanın 22'sinin (%55) erkek hastalar olduğu ve medyan yaşın 48 olduğu tespit edilmiştir. Hastaların çoğuna multipl miyelom (%35) tanısının konulduğu ve %58'inde en az bir komorbid hastalık olduğu tespit edilmiştir. Yüksek doz melfalan rejimi en çok uygulanan rejim (%25) olarak bulunmuştur. Lexicomp veri tabanında tespit edilen etkileşim sayısı, Medscape veri tabanından istatistiksel olarak daha fazla olduğu belirlenmiştir (299 vs 244; p<0.05). Eşlik eden hastalığı olan hastalarda, olmayan hastalara göre daha fazla etkileşim saptanmıştır (p<0.05). Çalışmamızda kemik iliği nakli hastalarında komorbid hastalık sayısı daha fazla olduğu gözlenmiştir. Bu hastaların akılcı tedavi ve izlem gerektiren ilaç etkileşimleri sayısı yüksek olabilmektedir. Bu ünitelerde hasta takibi, ilaç etkileşimlerinin yönetiminde klinik eczacıların önemli bir rolü olduğunu düşünüyoruz.

Anahtar Kelimeler

• İlaç etkileşimi
• kemik iliği transplantasyonu
• klinik eczacı

EVALUATION OF POTENTIAL DRUG INTERACTIONS IN THE ADULT BONE MARROW TRANSPLANTATION UNIT- A PROSPECTIVE STUDY

Öz

Objective: Bone marrow treatment (BMT) is a long and complicated process with multiple drug use can lead to drug-drug interactions. The aim of our study is to evaluate potential drug interactions (PDIs) in patients hospitalized in the adult bone marrow transplantation unit. Material and Method: This was a prospective and descriptive study conducted in an adult BMT unit in a private hospital in Turkey between January-June 2021. Sociodemogphrapics of the patients were recorded. PDIs were analyzed via Medscape and Lexicomp drug interaction checker. SPSS 15 was used for analysis. Result and Discussion: Of 40 patients 22 (55%) were male and the mean age was 46. Most of the patients were diagnosed with multiple myeloma (35%) and 58% of the patients had at least one comorbid disease. The number of PDIs detected in the Lexicomp database was statistically higher than in the Medscape database (299 vs 244; p<0.05). More PDIS were found in patients with concomitant disease than in patients without (p<0.05). The number of comorbid diseases was found to be higher in this population. Additionally, the number of PDIs was found to be high. We think that clinical pharmacists have an important role in patient monitoring and management of PDIs in BMT units.

Anahtar Kelimeler

• Bone marrow transplantation
• clinical pharmacist
• drug interactions

Kaynakça

1. 1. Ismail, M., Khan, S., Khan, F., Noor, S., Sajid, H., Yar, S., Rasheed, I. (2020). Prevalence and significance of potential drug-drug interactions among cancer patients receiving chemotherapy. BMC Cancer, 20(1), 335. [CrossRef]
2. 2. Glotzbecker, B., Duncan, C., Alyea III, E., Campbell, B., Soiffer, R. (2012). Important drug interactions in hematopoietic stem cell transplantation: what every physician should know. Biology of Blood and Marrow Transplantation: Journal of the American Society for Blood and Marrow Transplantation, 18(7), 989-1006. [CrossRef]
3. 3. Escudero-Vilaplana, V., Collado-Borrell, R., Hoyo-Muñoz, A., Gimenez-Manzorro, A., Calles, A., Osorio, S., Herranz-Alonso, A., Sanjurjo-Sáez, M. (2020). Potential drug interactions between targeted oral antineoplastic agents and concomitant medication in clinical practice. Expert Opinion on Drug Dafety, 19(8), 1041-1048. [CrossRef]
4. 4. Lopez-Martin, C., Garrido Siles, M., Alcaide-Garcia, J., Faus Felipe, V. (2014). Role of clinical pharmacists to prevent drug interactions in cancer outpatients: a single-centre experience. International Journal of Clinical Pharmacy, 36(6), 1251-1259. [CrossRef]
5. 5. Atayee, R.S., Sam, A.M., Edmonds, K.P. (2018). Patterns of Palliative Care Pharmacist Interventions and Outcomes as Part of Inpatient Palliative Care Consult Service. Journal of Palliative Medicine, 21(12), 1761-1767. [CrossRef]
6. 6. Lee, H., Ryu, K., Sohn, Y., Kim, J., Suh, G.Y., Kim, E. (2019). Impact on Patient Outcomes of Pharmacist Participation in Multidisciplinary Critical Care Teams: A Systematic Review and Meta-Analysis. Critical Care Medicine, 47(9), 1243-1250. [CrossRef]
7. 7. Clemmons, A.B., Alexander, M., DeGregory, K., Kennedy, L. (2018). The Hematopoietic Cell Transplant Pharmacist: Roles, Responsibilities, and Recommendations from the ASBMT Pharmacy Special Interest Group. Biology of Blood and Marrow Transplantation: Journal of the American Society for Blood and Marrow Transplantation, 24(5), 914-922. [CrossRef]
8. 8. Ferdjallah, A., Young, J.H., MacMillan, M.L. (2021). A Review of Infections After Hematopoietic Cell Transplantation Requiring PICU Care: Transplant Timeline Is Key. Frontiers in Pediatrics, 9, 634449. [CrossRef]

9. 9. Chen, L., Cheung, W.Y. (2014). Potential drug interactions in patients with a history of cancer. Current Oncology, 21(2), e212-e220. [CrossRef]
10. 10. Hadjibabaie, M., Badri, S., Ataei, S., Moslehi, A. H., Karimzadeh, I., Ghavamzadeh, A. (2013). Potential drug-drug interactions at a referral hematology-oncology ward in Iran: a cross-sectional study. Cancer Chemotherapy and Pharmacology, 71(6), 1619-1627. [CrossRef]
11. 11. van Leeuwen, R.W., Brundel, D.H., Neef, C., van Gelder, T., Mathijssen, R.H., Burger, D.M., Jansman, F.G. (2013). Prevalence of potential drug-drug interactions in cancer patients treated with oral anticancer drugs. British Journal of Cancer, 108(5), 1071-1078. [CrossRef]
12. 12. Luzze, B., Atwiine, B., Lugobe, H.M., Yadesa, T.M. (2022). Frequency, severity, and factors associated with clinically significant drug-drug interactions among patients with cancer attending Mbarara Regional Referral Hospital Cancer Unit, Uganda. BMC Cancer, 22(1), 1266. [CrossRef]
13. 13. Bibi, R., Azhar, S., Iqbal, A., Jabeen, H., Kalsoom, U.E., Iqbal, M.M., Nazeer, M. (2021). Prevalence of potential drug-drug interactions in breast cancer patients and determination of their risk factors. Journal of Oncology Pharmacy Practice: official publication of the International Society of Oncology Pharmacy Practitioners, 27(7), 1616-1622. [CrossRef]
14. 14. Sanchez, L., Bacle, A., Lamy, T., Le Corre, P. (2019). Potential drug-drug interactions and nephrotoxicity in hematopoietic stem cell transplant adult recipients during bone marrow transplantation unit stay. Cancer Chemotherapy and Pharmacology, 83(5), 827-835. [CrossRef]
15. 15. Eapen, M., Rocha, V., Sanz, G., Scaradavou, A., Zhang, M.J., Arcese, W., Sirvent, A., Champlin, R.E., Chao, N., Gee, A.P., Isola, L., Laughlin, M.J., Marks, D.I., Nabhan, S., Ruggeri, A., Soiffer, R., Horowitz, M.M., Gluckman, E., Wagner, J.E., Center for International Blood and Marrow Transplant Research, National Cord Blood Program of the New York Blood Center (2010). Effect of graft source on unrelated donor haemopoietic stem-cell transplantation in adults with acute leukaemia: a retrospective analysis. The Lancet. Oncology, 11(7), 653-660. [CrossRef]
16. 16. Anasetti, C., Logan, B.R., Lee, S.J., Waller, E.K., Weisdorf, D.J., Wingard, J.R., Cutler, C.S., Westervelt, P., Woolfrey, A., Couban, S., Ehninger, G., Johnston, L., Maziarz, R.T., Pulsipher, M.A., Porter, D.L., Mineishi, S., McCarty, J.M., Khan, S.P., Anderlini, P., Bensinger, W.I., Leitman, S.F., Rowley, S.D., Bredeson, C., Carter, S.L., Horowitz, M.M., Confer, D.L., Blood and Marrow Transplant Clinical Trials Network (2012). Peripheral-blood stem cells versus bone marrow from unrelated donors. The New England Journal of Medicine, 367(16), 1487-1496. [CrossRef]
17. 17. Scott, B.L., Pasquini, M.C., Logan, B.R., Wu, J., Devine, S.M., Porter, D.L., Maziarz, R.T., Warlick, E.D., Fernandez, H.F., Alyea, E.P., Hamadani, M., Bashey, A., Giralt, S., Geller, N.L., Leifer, E., Le-Rademacher, J., Mendizabal, A.M., Horowitz, M.M., Deeg, H.J., Horwitz, M.E. (2017). Myeloablative Versus Reduced-Intensity Hematopoietic Cell Transplantation for Acute Myeloid Leukemia and Myelodysplastic Syndromes. Journal of Clinical Oncology, 35(11), 1154-1161. [CrossRef]
18. 18. Trevisan, D.D., Silva, J.B., Oliveira, H.C., Secoli, S.R., Lima, M.H. (2015). Prevalence and clinical significance of potential drug-drug interaction in hematopoietic stem cell transplantation. Cancer Chemotherapy and Pharmacology, 75(2), 393-400. [CrossRef]
19. 19. Guastaldi, R.B., Reis, A.M., Figueras, A., Secoli, S.R. (2011). Prevalence of potential drug-drug interactions in bone marrow transplant patients. International Journal of Clinical Pharmacy, 33(6), 1002-1009. [CrossRef]
20. 20. Çam, B., Ulu Kılıç, A. (2020). Erişkin Hematoloji ve Kemik İliği Transplantasyonu (KİT) Ünitelerinde Yatan Hematolojik Maligniteli Hastalarda Gelişen Kan Dolaşımı Enfeksiyonlarının Araştırılması. Kırşehir Ahi Evran Üniversitesi Sağlık Bilimleri Dergisi, 1(3), 158-169.