Use of Potentially Inappropriate Medications in Older Allogeneic Hematopoietic Cell Transplantation Recipients

Bhargava, Divya; Arora, Mukta; DeFor, Todd E.; Brunstein, Claudio G.; Thyagarajan, Bharat; Jurdi, Najla El; Holtan, Shernan G.; Rashidi, Armin; Warlick, Erica D.; Ramesh, Vidhyalakshmi; Rogosheske, John; Bhatia, Smita; Weisdorf, Daniel J.

doi:10.1016/j.bbmt.2020.08.031

Cited by 11 publications

(4 citation statements)

References 24 publications

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“…Use of PIMs is associated with lower health‐related quality of life among elderly cardiac patients, 11 with increased health care utilization and costs in the general population 10 . Among BMT recipients, administration of PIMs is associated with an increased risk of falls, 4 Grade 3‐4 toxicities, discharge to a nursing facility, and nonrelapse mortality within the first year after BMT 5 . Among older allogeneic BMT recipients, PIM use was associated with delirium, nonrelapse mortality, and reduced overall survival 6 .…”

Section: Discussionmentioning

confidence: 99%

“…10 Among BMT recipients, administration of PIMs is associated with an increased risk of falls, 4 Grade 3-4 toxicities, discharge to a nursing facility, and nonrelapse mortality within the first year after BMT. 5 Among older allogeneic BMT recipients, PIM use was associated with delirium, nonrelapse mortality, and reduced overall survival. 6 However, a follow-up study found no association between PIM use and survival.…”

Section: Discussionmentioning

confidence: 99%

“…Older BMT survivors carry a high burden of comorbidity after transplantation 2,3 and often require multiple medications to manage these chronic health conditions. A few small studies have recently investigated PIM use in this population, focusing on the early posttransplant period and examining the association between PIMs and adverse outcomes such as delirium, falls, and early mortality, but with inconsistent findings across studies 4–7 . However, an examination of these issues in the early posttransplant phase in small samples and the lack of a nontransplant comparison group preclude an understanding of the magnitude of risk of PIM use in long‐term BMT survivors and the negative consequences associated with PIM use in this population.…”

Section: Introductionmentioning

confidence: 99%

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Potentially inappropriate medications in geriatric blood or marrow transplantation (BMT) survivors: A BMT Survivor Study report

Sanchez‐Luege

Landier

Dai

et al. 2022

Cancer

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Background: Blood or marrow transplantation (BMT) is increasingly offered to older individuals with hematologic malignancies. The high prevalence of chronic health conditions in such individuals necessitates use of multiple medications. Beers Criteria represent a list of potentially inappropriate medications (PIMs) shown to increase the risk of health problems in the elderly. We sought to determine the prevalence and predictors of PIM use in older BMT survivors and identify associations with health problems.Methods: Study participants were drawn from the BMT Survivor Study, a cohort study of patients transplanted at three US transplant centers between 1974 and 2014 and surviving ≥2 years. For this report, the survivors were aged ≥65 years.Siblings served as a comparison group. Participants self-reported sociodemographics, chronic health conditions, and medication use. Logistic regression analyses identified predictors of PIM use and associations with health problems.Results: Overall, PIM use was comparable between BMT survivors (49.4%) and siblings (49.3%) (odds ratio [OR] = 0.9; 95% CI, 0.7-1.2); however, BMT survivors were more likely to use >1 PIM (17.4% vs. 12.4%; OR = 1.5; 95% CI, 1.01-2.4) and central nervous system-related PIMs (8.3% vs. 4.3%; OR = 2.18; 95% CI, 1.17-4.09). Predictors of PIM use included presence of severe/life-threatening chronic health conditions (OR = 1.5; 95% CI, 1.1-2.0), and chronic graft versus host disease (OR = 1.7; 95% CI, 1.1-2.7). Survivors taking >1 PIM reported more issues with vertigo (OR = 2.3; 95% CI, 1.1-4.7), balance (OR = 2.6; 95% CI, 1.7-4.1), faintness/ dizziness (OR = 2.8; 95% CI, 1.8-4.6), and personal care (OR = 4.5; 95% CI, 1.4-14.8). Conclusions:This study shows the health problems associated with PIM use and identifies vulnerable populations at higher risk for PIM use, providing evidence for caution in using PIMs in high-risk populations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Potentially inappropriate medications in geriatric blood or marrow transplantation (BMT) survivors: A BMT Survivor Study report

Sanchez‐Luege

Landier

Dai

et al. 2022

Cancer

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“…Some of these features of drug treatments (PP, HPP or PIM) have been associated with negative clinical outcomes in older adults with blood cancers (7) . in patients with acute myeloid leukemia (8)(9) , non-Hodgkin's lymphoma (10) , or in patients undergoing allogeneic HSCT (11)(12) . Furthermore, kidney and liver impairment should be evaluated as HSCT patients are at an increased risk of developing early and late complications (13)(14) .…”

Section: Introductionmentioning

confidence: 99%

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

Malnoe,

Lamande,

Jouvance-Le Bail

et al. 2024

Ars Pharm

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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.

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Transplantation and Cellular Therapy for Older Adults—The MSK Approach

Lin,

Dahi,

Korc-Grodzicki

et al. 2024

Curr Hematol Malig Rep

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Use of Potentially Inappropriate Medications in Older Allogeneic Hematopoietic Cell Transplantation Recipients

Cited by 11 publications

References 24 publications

Potentially inappropriate medications in geriatric blood or marrow transplantation (BMT) survivors: A BMT Survivor Study report

Potentially inappropriate medications in geriatric blood or marrow transplantation (BMT) survivors: A BMT Survivor Study report

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

Transplantation and Cellular Therapy for Older Adults—The MSK Approach

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