Therapeutic pathways of allogeneic and autologous hematopoietic stem cell transplantation recipients: a hospital pharmacist’s perspective

Abstract

Introduction: Patients undergoing allogeneic and autologous hematopoietic stem cell transplantation (Allo-HSCT and Auto-HSCT) are at risk of pharmacotherapy-related problems. Objective: To describe in Allo-HSCT and Auto-HSCT patients from admission to hospital discharge, their therapeutic profile, and the time-course of biomarkers of renal and liver dysfunction, and of inflammation to display a more specific overview of drug therapy in HSCT patients. Method: Data were retrospectively extracted from the charts of 20 Allo-HSCT and 20 Auto-HSCT patients. The therapeutic pathway was described by the turn-over of drug treatments, the potentially inappropriate medications by using the GO-PIM scale, and the anticholinergic burden. Patho-physiological variations affecting clearance organs were characterized by the C-Reactive Protein (CRP) levels, and the hepatic and renal impairment evaluation tools (Model for End-stage Liver Disease score: MELD score, and glomerular filtration rate: GFR). Results: Compared to Auto-HSCT patients, Allo-HSCT patients had a higher number of drugs initiated during hospital stay leading to hyper-polypharmacy during the stay and at discharge. Around 35 % of drugs used were metabolized by CYP3A4 in HSCT patients. Anticholinergic burden increased at discharge in HSCT patients. Auto-HSCT patients ≥ 65 years were taking at least one PIM. High CRP levels were reported in HSCT recipients. MELD score increased and GFR decreased in Allo-HSCT patients while GFR slightly increased in Auto-HSCT patients. Conclusion: Clinical pharmacist should target polypharmacy, PIM and anticholinergic burden, and evaluate inflammation and both renal and hepatic functions in order to thoughtfully assess the clearance potential of patients and to suggest individualized dosing.