[Research on the Ratio of Anti-Cancer Drug Purchase Costs at Municipal Hospitals in the Aichi Prefecture].

We performed a study on the ratio of anti-cancer drug purchase costs at municipal hospitals in Aichi using meeting materials from the 2020 Aichi Prefectural Public Hospital Pharmacy Directors' Association. The ratio of anti-cancer drug purchase costs to all drug purchase costs at 17 hospitals was 41.5%(average)and 37.1%(median). In addition, we confirmed a positive correlation between all drug purchase costs and the ratio of anti-cancer drug purchase costs for each hospital(r= 0.537, 95%CI: 0.076-0.809, p=0.026). Furthermore, we conducted a univariate analysis on the background of hospitals where the ratio of anti-cancer drug purchase costs is ≥40%. As a result, we confirmed a significant difference(p<0.05)in the cases where there are more than 500 beds, with the approval of designated cancer hospitals, and with the department of hematology. This study clarified that hospitals with active anti-cancer drug treatment tended to increase drug purchase costs.

[Investigation of Anti-Cancer Drugs Suspected as Causative Agents of Allergy by Drug-Induced Lymphocyte Stimulation Test and Subsequent Re-Administration].

Twenty-one patients underwent a drug-induced lymphocyte stimulation test(DLST)withanti -cancer drugs suspected as causative agents of allergy between January 1, 2013, and December 31, 2017, at Ichinomiya Municipal Hospital, and 7 (33.3%)and 14 patients were positive and negative, respectively. Moreover, only 2 out of 21 people had a low value in lymphocyte blast transformation test induced by phytohemagglutinin, and their immune ability was maintained. Two patients suspected of drug eruption were re-administered after a positive determination. Letrozole was re-administered in 1 patient, but exemestane was administered after the patient relapsed. The other patient received lenalidomide in combination with dose-reduction and prednisolone(PSL), and the patient did not relapse. Seven patients were re-administered after negative determination, and none of them relapsed. These results confirmed that re-administration was possible depending on the type of side effects even in DLST positive cases; however, it was necessary to take various precautions. Moreover, DLST results were an index for finding the cause, and it is important to consider other diagnostic methods carefully during re-administration.

[Investigation and Measurement of Hypophosphatemia Induced by Tyrosine Kinase Inhibitors in Patients with Chronic Myeloid Leukemia].

We retrospectively investigated hypophosphatemia induced byty rosine kinase inhibitors(TKIs), in patients with chronic myeloid leukemia. Subjects evaluated were 14, 11, and 8 patients who received TKIs(imatinib, dasatinib and nilotinib), respectively, at the Department of Hematology in Ichinomiya Municipal Hospital, between 1st January 2006 and 31st Decem- ber 2016. The incidence of hypophosphatemia was 85.7%(12/14)for imatinib, 18.2%(2/11)for dasatinib, and 37.5%(3/ 8)for nilotinib, and hypophosphatemiaBgrade 3 occurred in 57.1%(8/14)of imatinib- and 9.1%(1/11)of dasatinibtreated patients. Instances of hypophosphatemiaBgrade 3 were not confirmed for nilotinib. Six patients received oral phosphate for hypophosphatemia, and all of these were patients who had been administered imatinib. We confirmed a significant improvement(p<0.05, 95%CI: 0.111-0.989)in serum phosphate levels after administration of oral phosphate, suggesting that it constitutes an effective measure against this situation.

[A Case of Hypophosphatemia Induced by Administration of Amrubicin in a Patient with Small Cell Lung Cancer].

A man in his 50s with small cell lung cancer received amrubicin as the fourth-line therapy from August 201X-1. Serum phosphorus levels before treatment were normal at 2.9mg/dL, but grade 2 hypophosphatemia(2.1mg/dL)was observed at the beginning of the 2nd course. He underwent laryngoplasty after the 4th course. Retreatment was initiated in June 201X due to disease progression. After reinitiating treatment, the disease developed to grade 3 hypophosphatemia. As we identi- fied lower levels(1.1mg/dL)at the start of the 10th course, a pharmacist proposed oral phosphate therapy to the attending physician, which we administered. After then, the levels improved to 2.2mg/dL; thus, oral phosphate therapy was interrupted. However, because of a decline in serum phosphorus levels to grade 3, we administered the therapy again, and observed favorable improvement. For hypophosphatemia in this case, general reasons in clinical practice were not applicable; thus, amrubicin is considered to be a most possible cause.

[A Case of a Multidisciplinary Team Approach to Serious Hand-Foot Syndrome Induced by High-Dose Cytarabine Therapy].

A 40's year-old female patient with acute myeloblastic leukemia received high-dose cytarabine(HD-Ara-C)as her third induction therapy. Because the pharmacist in charge noticed on a prior interview that she had experienced a mild skin eruption similar to hand-foot syndrome(HFS)in the previous round oftherapy(idarubicin and cytarabine), heparinoid lotion and hypoallergenic soap were used to prevent HFS. However, HFS occurred on day 3, and further developed on day 6 to grade 3 with painful erythema, swelling, and paresthesia affecting the entire surface of both hands. We cared for her with moisturization, lifestyle guidance, rotation of steroid ointment, and occlusive dressing techniques according to a multidisciplinary team approach composed ofa hematologist, dermatologist, pharmacist, and nurse. Her symptoms resolved on day 40.