16 month survey of cyclosporine utilization evaluation in allogeneic hematopoietic stem cell transplant recipients

Objectives: Graft versus host disease [GVHD] is a life threatening reaction in the stem cell transplantation process. Nowadays Cyclosporine is the most commonly utilized agent for GVHD prophylaxis and it has a major role in successful transplantation. Cyclosporine has been applied for many years in this field but it could be stated that currently no general consensus is available for its optimal method of administration. Conditions related to cyclosporine administration and possible related adverse reactions observed closely in our patients with the aim of constructing a comprehensive practice guideline in the future

Patients and Methods: Allogeneic stem cell transplant recipients who have been taking cyclosporine were monitored during and after their hospitalization while recording all observations on predefined questionnaires on the basis of periodic clinical and laboratory examinations for a 16 month period

Results: Mean recorded duration of infusions was 1.44 +/- 0.68 h and by twice daily administration, means intravenous and oral dose was 101.85 +/- 22.03 mg and 219.28 +/- 63.9 mg, respectively. A mean CsA trough level after about 12 h of specified unique doses was 223 +/- 65 ng/mL. We found hypertension, nephrotoxicity, neurotoxicity, hypertension, and dyslipidemia in about 14, 20, 48, and 94 percent of patients

Conclusions: This study proposed that permanent guidance of healthcare team according to a fixed and standard method of cyclosporine administration routine with using efficient facilities and protocols would be helpful considerably for an optimal pharmacotherapy

Potential of drug interactions among hospitalized cancer patients in a developing country

Cancer patients are more susceptible to adverse drug-drug interactions [DDIs] due to receiving multiple medications especially chemotherapy medications, hormonal agents and supportive care drugs. The aim of this study is to describe the prevalence of potential DDIs and to identify risk factors for these potential interactions in hospitalized cancer patients in a developing country

A cross-sectional study conducted by reviewing charts of 224 consecutive in hospitalized patients in hematology-oncology ward of a teaching hospital in Tehran, during a 12 month period from July 2009 to July 2010. "Drug Interaction Facts 2008, 2009: The Authority on Drug Interactions" was used for screening the potential drug-drug interactions. Potential interactions were classified by levels of severity and documentation

The median age of patients was 50 years, the length of hospital stay for patient was 5 days and the number of drugs per patient was 8 drugs. Two hundred and twenty-eight potential interactions were detected. Nearly 14% of the interactions were major and 60% were moderate. Approximately 9% and 10% potential interactions were graded as established and probable. In multivariate analysis, being older than 61 years old, suffering from hematologic cancer, source of cancer in different specific organs [esophagus, testis and cervices more than other sources], and number of ordered drugs for patients were independent predictors of having at least one potential DDI in hospital order. Suffering from hematologic cancer, source of cancer in different organs, length of hospital stay and number of ordered drugs for patients were independent predictors for number of interactions per patients

Having a DDI seems to be more likely to occur in patients older than 61 years old. Hematologic cancers, having more medications in physician's order, longer length of hospital stay, esophageal cancer, testicular cancer and cervical cancer have related to having a DDI and also having more number of interactions

Plerixafor in the treatment of stem cell mobilization failure; first experience in Iran

High-dose chemotherapy and autologous stem cell transplantation [SCT] have become an effective care for many patients with hematological malignancies. Harvesting the stem cells is one the most important parts of SCT. The two most commonly used mobilization regimens are the use of granulocyte colony-stimulating factor [G-CSF] or G-CSF plus chemotherapy. However, about 10-30% of patients are unable to collect enough cells to support HSCT due to previous chemotherapies, radiation, marrow involvement or fibrosis. In multiple myeloma patients, it is hard to collect enough stem cells when the bone marrow is extensively involved. Plerixafor has emerged as a novel mobilizing agent and its efficacy has been shown in two phase III studies. Considering the importance of autologous SCT in patients with multiple myeloma, we report the first successful Iranian experience at Tehran Taleghani bone marrow transplantation center using plerixafor to mobilize stem cells in a patient with refractory multiple myeloma with extensive bone marrow involvement who failed mobilization with G-CSF

Attempt to suicide in young ages with epilepsy

The suicidal rate among epileptic patients is up to 5 times more than general population and depression is the most common mood disturbance among them while usually under noticed. This study was performed to determine possible symptoms of psychiatric disorders for suicidal behavior in pediatric patients with epilepsy that had attempted suicide. Among medical records of 1169 patients under 17 years of age being admitted to the exclusive university hospital for poisoning in Tehran since April 2006 to Feb 2008 due to attempt to suicide, 31 cases [13 male and 18 female] with mean age 15.8 +/- 1.3 years had concomitant epilepsy. Mental status and epilepsy data sheet of these patients were analyzed. The psychological evaluation of these 31 cases revealed long lasting symptoms of psychological disorder in 21 [91.4%] cases before their attempt to suicide while only 5[16%] cases had been noticed for psychiatric care and merely 3 of them had been under treatment. Despite strong correlation between affective disorders and epilepsy it is unfortunately under-diagnosed or undertreated. Since overdose of antiepileptic drugs used for treatment of epilepsy may be lethal, dismissing suicidal behavior can be life threatening