1
|
Ruiz-Boy S, Pedraza A, Prat M, Salas MQ, Carcelero E, Riu-Viladoms G, Suárez-Lledó M, Monge-Escartín I, Rodríguez-Lobato LG, Martínez-Roca A, Rovira M, Martínez C, Gallego C, Urbano-Ispizua Á, Sánchez J, Marcos MÁ, Fernández-Avilés F. At-Home Foscarnet Administration in Patients with Cytomegalovirus Infection Post-Allogeneic Stem Cell Transplantation: A Unicentric, Safe, and Feasible Program. Pharmaceuticals (Basel) 2023; 16:1741. [PMID: 38139867 PMCID: PMC10748136 DOI: 10.3390/ph16121741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Cytomegalovirus (CMV) infection is a relevant cause of morbimortality in patients receiving allogeneic stem cell transplantation (allo-HCT). Foscarnet (FCN) is an effective drug against CMV administered intravenously and usually on an inpatient basis. The Home Care Unit (HCU) for hematologic patients at our hospital designed an at-home FCN administration model to avoid the hospitalization of patients requiring FCN treatment. This study analyzes whether the at-home administration of FCN is as safe and effective as its hospital administration. We collected and compared demographic, clinical, analytical, and economic data of patients with CMV infection post-allo-HCT who received FCN in the hospital (n = 16, 17 episodes) vs. at-home (n = 67, 88 episodes). The proportions of patients with cured CMV infections were comparable between the two groups (65.9% vs. 76.5%, p = 0.395). The median duration of FCN treatment was 15 (interquartile range [IQR] 9-23) and 14 (IQR 11-19) days in the HCU and inpatient cohorts, respectively (p = 0.692). There were no significant differences in the FCN toxicities between groups except for hypocalcemia (26.1% vs. 58.8%, p = 0.007), which was more prevalent in the inpatient cohort. A significant cost-effectiveness was found in the HCU cohort, with a median savings per episode of EUR 5270. It may be concluded that home administration of FCN is a safe, effective, and cost-efficient therapeutic option for patients with CMV infection and disease.
Collapse
Affiliation(s)
- Sonia Ruiz-Boy
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (M.P.); (E.C.); (G.R.-V.); (I.M.-E.)
| | - Alexandra Pedraza
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
- Blood Bank Department, Biomedical Diagnostic Center, Blood and Tissue Bank, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Marta Prat
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (M.P.); (E.C.); (G.R.-V.); (I.M.-E.)
| | - Maria Queralt Salas
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
| | - Esther Carcelero
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (M.P.); (E.C.); (G.R.-V.); (I.M.-E.)
| | - Gisela Riu-Viladoms
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (M.P.); (E.C.); (G.R.-V.); (I.M.-E.)
| | - María Suárez-Lledó
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
| | - Inés Monge-Escartín
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (M.P.); (E.C.); (G.R.-V.); (I.M.-E.)
| | - Luis Gerardo Rodríguez-Lobato
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
| | - Alexandra Martínez-Roca
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - Montserrat Rovira
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
| | - Carmen Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
| | - Cristina Gallego
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - Álvaro Urbano-Ispizua
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
| | - Joan Sánchez
- Financial-Economic Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - María Ángeles Marcos
- Microbiology Department, Hospital Clínic de Barcelona, University of Barcelona, ISGlobal, CIBERINFEC (Centro de Investigación Biomédica En Red enfermedades INFECciosas), 08036 Barcelona, Spain;
| | - Francesc Fernández-Avilés
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| |
Collapse
|
2
|
Fang H, Yan HHN, Bilardi RA, Flensburg C, Yang H, Barbour JA, Siu HC, Turski M, Chew E, Xu Z, Lam ST, Sharma R, Xu M, Li J, Ip HW, Cheung CYM, Huen MSY, Sweet-Cordero EA, Majewski IJ, Leung SY, Wong JWH. Ganciclovir-induced mutations are present in a diverse spectrum of post-transplant malignancies. Genome Med 2022; 14:124. [PMID: 36316687 PMCID: PMC9620652 DOI: 10.1186/s13073-022-01131-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/20/2022] [Indexed: 11/04/2022] Open
Abstract
Background Ganciclovir (GCV) is widely used in solid organ and haematopoietic stem cell transplant patients for prophylaxis and treatment of cytomegalovirus. It has long been considered a mutagen and carcinogen. However, the contribution of GCV to cancer incidence and other factors that influence its mutagenicity remains unknown. Methods This retrospective cohort study analysed genomics data for 121,771 patients who had undergone targeted sequencing compiled by the Genomics Evidence Neoplasia Information Exchange (GENIE) or Foundation Medicine (FM). A statistical approach was developed to identify patients with GCV-associated mutational signature (GCVsig) from targeted sequenced data of tumour samples. Cell line exposure models were further used to quantify mutation burden and DNA damage caused by GCV and other antiviral and immunosuppressive drugs. Results Mutational profiles from 22 of 121,771 patient samples in the GENIE and FM cohorts showed evidence of GCVsig. A diverse range of cancers was represented. All patients with detailed clinical history available had previously undergone solid organ transplantation and received GCV and mycophenolate treatment. RAS hotspot mutations associated with GCVsig were present in 9 of the 22 samples, with all samples harbouring multiple GCV-associated protein-altering mutations in cancer driver genes. In vitro testing in cell lines showed that elevated DNA damage response and GCVsig are uniquely associated with GCV but not acyclovir, a structurally similar antiviral. Combination treatment of GCV with the immunosuppressant, mycophenolate mofetil (MMF), increased the misincorporation of GCV in genomic DNA and mutations attributed to GCVsig in cell lines and organoids. Conclusions In summary, GCV can cause a diverse range of cancers. Its mutagenicity may be potentiated by other therapies, such as mycophenolate, commonly co-prescribed with GCV for post-transplant patients. Further investigation of the optimal use of these drugs could help reduce GCV-associated mutagenesis in post-transplant patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13073-022-01131-w.
Collapse
Affiliation(s)
- Hu Fang
- grid.194645.b0000000121742757School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China ,grid.263488.30000 0001 0472 9649Department of Research & Development, South China Hospital, Health Science Center, Shenzhen University, Shenzhen, 518116 China
| | - Helen H. N. Yan
- grid.194645.b0000000121742757Department of Pathology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China ,Centre for Oncology and Immunology,, Hong Kong Science Park, Hong Kong SAR, China
| | - Rebecca A. Bilardi
- grid.1042.70000 0004 0432 4889The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC 3052 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, 1G Royal Parade, Parkville, VIC 3052 Australia
| | - Christoffer Flensburg
- grid.1042.70000 0004 0432 4889The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC 3052 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, 1G Royal Parade, Parkville, VIC 3052 Australia
| | - Haocheng Yang
- grid.194645.b0000000121742757School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jayne A. Barbour
- grid.194645.b0000000121742757School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hoi Cheong Siu
- grid.194645.b0000000121742757Department of Pathology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Michelle Turski
- grid.266102.10000 0001 2297 6811Division of Hematology/Oncology, Department of Pediatrics, University of California San Francisco, San Francisco, CA USA
| | - Edward Chew
- grid.1042.70000 0004 0432 4889The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC 3052 Australia
| | - Zhen Xu
- grid.1042.70000 0004 0432 4889The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC 3052 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, 1G Royal Parade, Parkville, VIC 3052 Australia
| | - Siu T. Lam
- grid.194645.b0000000121742757Centre for PanorOmic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Rakesh Sharma
- grid.194645.b0000000121742757Centre for PanorOmic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mengya Xu
- grid.194645.b0000000121742757School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Junshi Li
- grid.194645.b0000000121742757School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ho W. Ip
- grid.415550.00000 0004 1764 4144Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - Carol Y. M. Cheung
- grid.415550.00000 0004 1764 4144Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Michael S. Y. Huen
- grid.194645.b0000000121742757School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - E. Alejandro Sweet-Cordero
- grid.266102.10000 0001 2297 6811Division of Hematology/Oncology, Department of Pediatrics, University of California San Francisco, San Francisco, CA USA
| | - Ian J. Majewski
- grid.1042.70000 0004 0432 4889The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC 3052 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, 1G Royal Parade, Parkville, VIC 3052 Australia
| | - Suet Y. Leung
- grid.194645.b0000000121742757Department of Pathology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China ,Centre for Oncology and Immunology,, Hong Kong Science Park, Hong Kong SAR, China ,grid.194645.b0000000121742757Centre for PanorOmic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China ,grid.194645.b0000000121742757The Jockey Club Centre for Clinical Innovation and Discovery, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jason W. H. Wong
- grid.194645.b0000000121742757School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China ,Centre for Oncology and Immunology,, Hong Kong Science Park, Hong Kong SAR, China ,grid.194645.b0000000121742757Centre for PanorOmic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China ,grid.194645.b0000000121742757The Jockey Club Centre for Clinical Innovation and Discovery, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| |
Collapse
|