PMID- 33836888 OWN - NLM STAT- MEDLINE DCOM- 20210702 LR - 20210702 IS - 2666-6367 (Electronic) IS - 2666-6367 (Linking) VI - 27 IP - 4 DP - 2021 Apr TI - Impact of Polypharmacy Prior to Allogeneic Hematopoietic Stem Cell Transplantation in Older Adults. PG - 344.e1-344.e5 LID - S2666-6367(21)00001-4 [pii] LID - 10.1016/j.jtct.2021.01.001 [doi] AB - Polypharmacy is common in older adults with cancer, but there is little evidence evaluating the impact of polypharmacy and other medication hazards on allogeneic hematopoietic cell transplantation (alloHCT) outcomes. A small number of prior studies have evaluated the impact of potentially inappropriate medication (PIM) use in the setting of alloHCT, with mixed results. We evaluated the effects of pre-alloHCT polypharmacy, PIM use, and drug-drug interactions (DDIs) on post-alloHCT outcomes, including overall survival (OS), progression-free survival (PFS), non-relapse mortality (NRM), hospital length of stay (LOS), number of non-hematologic grade >/=3 adverse events (AEs) within 100 days after alloHCT, and number of readmissions within the first 100 days after alloHCT. The study population was a single-center prospective cohort of 148 patients >/= 50 years of age. Pre-alloHCT medication lists were retrospectively collected from the electronic medical record, including both scheduled and as-needed medications. PIMs were defined by a modified 2019 American Geriatrics Society Beers Criteria. DDIs were analyzed using Lexi-Interact. Polypharmacy was common in this population; the median number of medications was seven (range, 0 to 23). Fifty-two patients (35%) were prescribed nine or more medications, and 73 patients (49%) had at least one PIM prescribed. The median number of DDIs was three (range, 0 to 31), and the most common severity was major (48%). After adjusting for age and Hematopoietic Cell Transplant Comorbidity Index (HCTCI), both the number of all medications and number of scheduled medications were associated with inferior OS, with hazard ratios (HRs) of 1.07 (95% confidence interval [CI], 1.01 to 1.12; P = .02) and 1.08 (95% CI, 1.00 to 1.15; P = .04), respectively. Receipt of nine or more scheduled medications was associated with inferior OS (HR, 1.92; 95% CI, 1.11 to 3.32; P = .02). The number of PIMs was also significantly associated with OS (HR, 1.24; 95% CI, 1.00 to 1.54, P = .05). After adjusting for age, HCTCI, and total number of medications, a greater number of DDIs were significantly associated with longer hospital length of stay (difference, 0.74 days; 95% CI, 0.09 to 1.40, P = .03). In adjusted analyses, there were no significant polypharmacy-related predictors of NRM, LOS, or non-hematologic grade >/=3 AEs. These data demonstrate the utility of pre-alloHCT polypharmacy, PIM use, and DDIs as important prognostic factors and support routine pre-alloHCT medication review by physicians and pharmacists with a goal of appropriate de-prescribing where possible. CI - Copyright (c) 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved. FAU - Sugidono, Matthew AU - Sugidono M AD - Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California. FAU - Lo, Mimi AU - Lo M AD - Department of Pharmaceutical Services, University of California San Francisco Medical Center, San Francisco, California. FAU - Young, Rebecca AU - Young R AD - Department of Pharmaceutical Services, University of California San Francisco Medical Center, San Francisco, California. FAU - Rosario, Kimberly AU - Rosario K AD - School of Pharmacy, University of California San Francisco, San Francisco, California. FAU - Jung, Yoonie AU - Jung Y AD - School of Pharmacy, University of California San Francisco, San Francisco, California. FAU - Huang, Chiung-Yu AU - Huang CY AD - Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California. FAU - Sheng, Ying AU - Sheng Y AD - Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California. FAU - Huang, Li-Wen AU - Huang LW AD - Division of Hematology/Oncology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco California. FAU - Olin, Rebecca L AU - Olin RL AD - Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco California; Division of Hematology and Medical Oncology, Department of Medicine, University of California San Francisco, San Francisco, California. Electronic address: rebecca.olin@ucsf.edu. LA - eng PT - Journal Article DEP - 20210107 PL - United States TA - Transplant Cell Ther JT - Transplantation and cellular therapy JID - 101774629 SB - IM MH - Aged MH - *Hematopoietic Stem Cell Transplantation MH - Humans MH - Inappropriate Prescribing MH - Neoplasm Recurrence, Local MH - *Polypharmacy MH - Prospective Studies MH - Retrospective Studies MH - United States OTO - NOTNLM OT - Allogeneic transplantation OT - Drug-drug interactions OT - Hematopoietic stem cell transplantation OT - Older adults OT - Polypharmacy OT - Potentially inappropriate medication EDAT- 2021/04/11 06:00 MHDA- 2021/07/03 06:00 CRDT- 2021/04/10 05:32 PHST- 2020/09/15 00:00 [received] PHST- 2020/12/10 00:00 [revised] PHST- 2021/01/03 00:00 [accepted] PHST- 2021/04/10 05:32 [entrez] PHST- 2021/04/11 06:00 [pubmed] PHST- 2021/07/03 06:00 [medline] AID - S2666-6367(21)00001-4 [pii] AID - 10.1016/j.jtct.2021.01.001 [doi] PST - ppublish SO - Transplant Cell Ther. 2021 Apr;27(4):344.e1-344.e5. doi: 10.1016/j.jtct.2021.01.001. Epub 2021 Jan 7.