Amber Lawson

Fatal Rhizopus Pneumonia in Allogeneic Stem Cell Transplant Patients Despite Posaconazole Prophylaxis: Two Cases and Review of the Literature

Posaconazole is a triazole with broad spectrum of activity against multiple fungi including members of the fungal order Mucorales. This activity has been shown both in clinical and in vitro studies, which are critically reviewed here. It has become very popular in prophylaxis in acute myelogenous leukemia (AML) induction and in the graft-versus-host disease (GVHD) settings after 2 recent prospective trials that showed advantage of posaconazole prophylaxis compared to fluconazole or itraconazole. In this report, 2 patients are presented, in whom, despite posaconazole prophylaxis, invasive and ultimately fatal Rhizopus pulmonary infections developed. These cases are similar to a previously reported case of Rhizopus infection in a stem cell transplant recipient who also received posaconazole, indicating a potential newly recognized pattern of breakthrough infections in patients receiving posaconazole prophylaxis.

Description of Current Practices of Empiric Chemotherapy Dose Adjustment in Obese Adult Patients

PURPOSE The literature is not clear on the best method to empirically dose chemotherapy in obese adult patients. The purpose of our study was to determine whether a standard of practice existed, characterize current practices of empiric dose adjustment (EDA) in obese adult patients, and identify factors affecting this decision. METHODS An electronic survey was distributed to oncologists and board-certified oncology pharmacists via the Association of Community Cancer Centers and Board of Pharmaceutical Specialties e-mail distribution lists. The survey contained patient scenarios assessing the impact of various factors on EDA of chemotherapy, demographic information, and details of institutional policies. RESULTS Responses were collected from 174 professionals. Pharmacists comprised 95% of respondents. Of these, 50% practiced in academic medical centers, and 19% practiced in institutions with a standard of practice regarding EDA for obesity. The most common methods of EDA were use of an adjusted body weight in the body-surface area (BSA) equation and capping BSA. Factors with the most impact on EDA were curative intent, degree of obesity, type of chemotherapy, and performance status. CONCLUSION There is no standard of practice regarding EDA of chemotherapy in obese adult patients. Although many factors affect this decision, intent of treatment, degree of obesity, performance status, age, and type of medication seem to carry the most weight.

Incidence and risk factors of clinically significant chemotherapy-induced thrombocytopenia in patients with solid tumors*:

Purpose and relevance. Chemotherapy-induced thrombocytopenia (CIT) can be a significant problem in patients with cancer, leading to numerous clinical complications. Understanding the types of patients at risk for these complications is essential to improve monitoring, counseling, and provide future targeted prophylaxis measures. Previous studies have limited prospective utility since they do not examine risk factors associated with complications from multi-agent regimens. This evaluation aims to identify the incidence and risk factors associated with clinical complications of CIT in patients receiving common chemotherapy regimens. Methods. Retrospective evaluation of adult patients receiving first or second line regimens for the most common solid tumors associated with high rates (≥5%) of laboratory diagnosed thrombocytopenia. Patients were examined for clinically significant CIT (defined as platelet count <75,000 cells/µL as well as the presence of one of the following: bleeding, dose reduction/delay, platelet transfusion, or therapy cessation) and associated risk factors. Results. About 254 patients receiving a total of 278 regimens were evaluated. The incidence of clinically significant CIT = 10.1%; complications were most common in patients receiving cisplatin/gemcitabine for bladder cancer (57%), or carboplatin/gemcitabine (29%) or cisplatin/etoposide (18%) for lung cancer. Bladder cancer (OR = 13.7 (2.89–64.7); p = 0.001) and concurrent or recent infection (OR = 3.8 (1.45–10.1); p = 0.007) was found to increase the risk of clinical complications while smoking was found to have a protective effect (OR = 0.17 (0.04–0.71)). Conclusions. The incidence of clinically significant CIT is most commonly seen in patients using cisplatin/gemcitabine for bladder cancer, or carboplatin/gemcitabine or cisplatin/etoposide for lung cancer. Further evaluation of these patients is warranted.

Osteonecrosis of the Jaw Associated With Bisphosphonate Therapy

The overall incidence of bisphosphonate-associated osteonecrosis of the jaw is relatively low. Preventative measures such as maintaining good oral hygiene are likely the best management strategy for the disorder.

Complications associated with treatment of malignancies: a focus on avascular necrosis of the bone.

Corticosteroids, the second most common cause of avascular necrosis, are a primary treatment for nearly all hematologic malignancies and are used in essentially all solid tumor patients to prevent or treat toxicities (eg, nausea and vomiting).

Are all opioids created equal

When choosing an opioid for pain management, the pharmacology and pharmacokinetic profile of each agent and how these characteristics may affect individual patients should be considered.