Background The Milan National Cancer Institute Pharmacy began a collaboration with the haematology and bone marrow transplantation (ETMO) department, to optimise concomitant conditioning protocols of bone marrow transplants; the pharmacokinetics and pharmacodynamics are affected by the high doses of chemotherapy administered. The drugs analysed were those in the conditioning schedules used in accordance with international guidelines.
Purpose To provide a practical guide for managing drug interactions between the drugs commonly used by ETMO and those in the transplant conditioning schedules.
Materials and Methods The presence of the ward pharmacist, funded by the Italian Haematology Society, allowed the daily management of treatment to be investigated. Databases were used (Micromedex, Codifa) and literature meta-analyses were conducted, in order to obtain the pharmacokinetic and pharmacodynamic characteristics of these drugs and possible interactions.
Results Within our Institute, 72 transplants that used conditioning were performed in a year, 32 autologous and 40 allogeneic. In particular, 28 transplants used a high-dose melphalan scheme, 28 used thiotepa/fludarabine/cyclophosphamide, 4 used BEAM, 4 used TBI/fludarabine/cyclophosphamide and 8 used the KROGER scheme. Therefore the interactions between drugs used in the protocols themselves and the drugs commonly used within the department by transplant patients were analysed. For this purpose the following drugs were considered: ciclosporin, allopurinol, acetazolamide and IPP. Following this analysis, it was shown that there were significant interactions between the drugs used in the conditioning scheme and drugs commonly used in patients with bone marrow transplants.
Conclusions The pharmacist set up a means of enabling a clinician to browse for a more informed choice: dedicated schemes are being developed, in which they report any interactions observed, associated with the treatment protocols. All this has therefore contributed to the rational use of the drugs and resources, for example the use of antifungals after transplantation and not before, and the introduction of pantoprazole instead of omeprazole. A future goal will be the analysis of the interactions between the drugs and concomitant haematology chemotherapy.
No conflict of interest.
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