Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Acute Kidney Injury in Patients Undergoing HCT

Biol Blood Marrow Transplant; ePub 2017 Dec 29; Clemmons, et al

Acute kidney injury (AKI) risk in patients undergoing hematopoietic cell transplantation (HCT) seems to vary depending on which antimicrobial medications are used, researchers concluded after conducting a single-center retrospective review involving 170 individuals. Participants underwent either autologous (n=110) or allogeneic (n=60) HCT. Investigators compared AKI incidence in patients who received vancomycin with either piperacillin/tazobactam concomitantly or cefepime alone prior to engraftment. Among the results:

  • Overall, 68% of patients who received piperacillin/tazobactam experienced AKI, vs 27% of those who were given cefepime.
  • Those receiving antimicrobials concomitantly were >5 time more likely to experience AKI after adjusting for hypotension.
  • Time to onset of AKI was more common within 48 hours of concomitant antimicrobial use (53% and 26%, respectively).
  • AKI incidence in autologous recipients in the 2 medication groups was 59% and 22%, respectively.
  • In the allogeneic sub-group, AKI incidence was 79% and 39%, respectively.
  • AKI resolution by discharge date was similar.

Citation:

Clemmons A, Bech C, Pantin J, Ahmad I. Acute kidney injury in hematopoietic cell transplantation patients receiving vancomycin and piperacillin/tazobactam versus vancomycin and cefepime. [Published online ahead of print December 29, 2017]. Biol Blood Marrow Transplant. doi:10.1016/j.bbmt.2017.12.799.

This Week's Must Reads

Higher AML, MDS risk linked to autotransplants, Radivoyevitch T et al. Leuk Res. 2018 Jul 19. pii: S0145-2126(18)30160-7

CMS wants to flatten E/M payments, CMS proposed rule, CMS-1693-P

Lay health workers can assist with end-of-life care, Patel MI et al. JAMA Oncology. 2018 Jul 26. doi: 10.1001/jamaoncol.2018.2446.

New guidelines from the UK on chronic lymphocytic leukemia, Schuh AH et al. Br J Haematol. 2018 Jul 15. doi: 10.1111/bjh.15460

JAK1/2 inhibitors tied to increased B-cell lymphoma risk, Porpaczy E et al. Blood. 2018 Jun 14. doi: 10.1182/blood-2017-10-810739.

Must Reads in Myelodysplastic Syndrome

JAK1/2 inhibitors tied to increased B-cell lymphoma risk, Porpaczy E et al. Blood. 2018 Jun 14. doi: 10.1182/blood-2017-10-810739.

Romiplostim safety confirmed in thrombocytopenic patients with low-risk myelodysplastic syndromes, Kantarjian H et al. The Lancet Haematology March 2018, Pages e117-e126 https://doi.org/10.1016/S2352-3026(18)30016-4

Simplifying the URD Selection Process for HCT, Biol Blood Marrow Transplant.; ePub 2018 Feb 14; Shaw, Logan, et al

Genetic Risk Model for MDS Shown to Be Feasible, Am J Hematol; ePub 2018 Feb 24; Gangat, et al

This Predicts Risk of Early Relapse, Death in MM , Biol Blood Marrow Transplant; ePub 2018 Feb 23; Cowan, et al