Twice-daily intravenous bolus tacrolimus infusion for acute graft-vs-host disease prophylaxis

Hayek, Fadi; Al-Ghawi, Hayma; Allen, Jeff W.; Baize, Timothy; Mudd, Lisa; Mehta, Akshay; Soni, Sandeep; Cheerva, A.; Herzig, Geoffrey P.; Herzig, Roger H.

doi:10.1016/j.bbmt.2004.12.133

Cited by 5 publications

(2 citation statements)

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“…Similar challenges at other institutions have prompted research on the safety and efficacy of tacrolimus via shortened infusion durations. 4,5 Although there are no reports in the literature describing experience in an adult population, a 2-h IIV infusion of tacrolimus has been proposed as a safe and efficacious practice for the prevention of GVHD in the pediatric setting. 4 For the last 15 years or more, at our institution, tacrolimus has been administered as a 2-h IIV every 12 h in the allogeneic HSCT unit.…”

Section: Introductionmentioning

confidence: 99%

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Safety of two-hour intermittent intravenous infusions of tacrolimus in the allogeneic hematopoietic stem cell transplantation unit

Bacopoulos

Yang

et al. 2020

J Oncol Pharm Pract

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Background: Administering intravenous (IV) tacrolimus by 24-hour continuous IV infusion (CIV), as recommended by the product monograph, poses significant logistical challenges in the allogeneic hematopoietic stem cell transplantation (HSCT) unit because it requires a dedicated central venous catheter lumen. Consequently, at our institution, tacrolimus has been administered via two-hour intermittent IV infusions (IIV) every twelve hours in the HSCT unit. Administration by IIV is not the standard of practice and shorter infusion times are cautioned due to higher rates of nephrotoxicity, neurotoxicity and infusion-related reactions (IRRs), although there is a paucity of data to support this claim. The primary objective of this retrospective study was to evaluate the safety of a two-hour IIV of tacrolimus in an adult HSCT population. Efficacy was evaluated as a secondary endpoint. Methods and Patients: We performed a retrospective chart review of all patients who received IV tacrolimus at our institution from January 2002-January 2016. We reviewed 104 patients who received 118 tacrolimus treatment courses by IIV (TTC) [median number of doses per TTC=22, range 1-158, interquartile range (IQR) = 28]. Primary outcomes collected include rates of nephrotoxicity, neurotoxicity and IRRs that occurred during TTC. The incidence of acute graft-versus-host disease (aGVHD) and disease relapse within 180 days of transplant were collected to evaluate efficacy. Results and Discussion: There were sixteen incidences (13.6%) of nephrotoxicity, defined as a doubling of serum creatinine from baseline. Nephrotoxicity resolved in all but six (5.1%) cases. Precipitating factor for nephrotoxicity unrelated to tacrolimus were identified by the physician in all six cases. There were 40 incidences (34.5%) of neurotoxicity [seizure, posterior reversible encephalopathy syndrome (PRES), tremor, paresthesia, visual disturbance], of which, eight (6.8%) were considered serious (seizure and/or PRES). All neurotoxicity reverted to baseline or resolved completely. One grade 2 infusion reaction occurred and resolved without discontinuation of tacrolimus. In the subset of patients who received tacrolimus for the prevention of aGVHD (n=41), seven patients (17.1%) developed grade II-IV aGVHD. Nine patients (8.7%) experienced relapse of their disease. Conclusions: We propose that a two-hour IIV of tacrolimus is a safe method of administration in the adult HSCT setting. Additional safety and efficacy data from other institutions will provide external validity to this conclusion.

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Section: Introductionmentioning

confidence: 99%

“…Similar challenges at other institutions have prompted research on the safety and efficacy of tacrolimus via shortened infusion durations. 4,5…”

Section: Introductionmentioning

confidence: 99%

Safety of two-hour intermittent intravenous infusions of tacrolimus in the allogeneic hematopoietic stem cell transplantation unit

Bacopoulos

Yang

et al. 2020

J Oncol Pharm Pract

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Immunosuppression for lung transplant recipients

Snell

Paraskeva

Levvey

et al. 2014

Curr Respir Care Rep

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Immunosuppression and Allograft Rejection Following Lung Transplantation: Evidence to Date

Snell

Westall

Paraskeva

2013

Drugs

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The enduring success of lung transplantation is built on the use of immunosuppressive drugs to stop the immune system from rejecting the newly transplanted lung allograft. Most patients receive a triple-drug maintenance immunosuppressive regimen consisting of a calcineurin inhibitor, an antiproliferative and corticosteroids. Induction therapy with either an antilymphocyte monoclonal or an interleukin-2 receptor antagonist are prescribed by many centres aiming to achieve rapid inhibition of recently activated and potentially alloreactive T lymphocytes. Despite this generic approach acute rejection episodes remain common, mandating further fine-tuning and augmentation of the immunosuppressive regimen. While there has been a trend away from cyclosporine and azathioprine towards a preference for tacrolimus and mycophenolate mofetil, this has not translated into significant protection from the development of chronic lung allograft dysfunction, the main barrier to the long-term success of lung transplantation. This article reviews the problem of lung allograft rejection and the evidence for immunosuppressive regimens used both in the short- and long-term in patients undergoing lung transplantation.

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Twice-daily intravenous bolus tacrolimus infusion for acute graft-vs-host disease prophylaxis

Cited by 5 publications

References 0 publications

Safety of two-hour intermittent intravenous infusions of tacrolimus in the allogeneic hematopoietic stem cell transplantation unit

Safety of two-hour intermittent intravenous infusions of tacrolimus in the allogeneic hematopoietic stem cell transplantation unit

Immunosuppression for lung transplant recipients

Immunosuppression and Allograft Rejection Following Lung Transplantation: Evidence to Date

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