Oral levetiracetam for prevention of busulfan-induced seizures in adult hematopoietic cell transplant.

Background Antiseizure prophylaxis is recommended when high-dose of busulfan is given as part of the conditioning regimens in the allogenic hematopoietic stem cell transplant. Phenytoin has been widely used but its pharmacokinetics and pharmacodynamics profile makes its use complicated. Levetiracetam is a safe, effective and well tolerated antiseizure drug with good results in epileptic patients. Objective To describe our experience using oral (p.o) levetiracetam 1000 mg every 12 h (q12h) as an antiseizure prophylaxis, evaluating its preventive effects and adverse event rates after a high-dose of intravenous (i.v.) busulfan, as part of the conditioning regimen Methods Retrospective study of patients who underwent an allogenic hematopoietic stem cell transplant with a conditioning regimen based on high-dose of busulfan between January and November 2017. Results The study population comprised 36 patients, of whom 18 (50%) had acute myeloid leukemia as diagnosis. No seizures occurred in any patient. Levetiracetam was well tolerated and no serious adverse events were reported. Conclusions Our results suggest that giving levetiracetam at 1000 mg q12h p.o starting 12 h before the administration of i.v. busulfan until 48 h after the last dose, can be used as an alternative in the prevention of busulfan-induced seizures in adults.

Use and safety of denosumab in cancer patients.

Background Few data have been reported on the use and safety of denosumab in patients with solid tumors and bone metastasis in clinical practice. Objectives To describe the use of denosumab and to analyze its adverse effects (AE) in tertiary hospital cancer outpatients. Methods Retrospective study of patients who started denosumab between January 2013 and June 2015. We recorded demographic, clinical, and treatment-related variables, as well as the reasons for discontinuation and AE. Results The study population comprised 104 patients, of whom 86 (82.7%) were receiving concomitant outpatient cancer treatment and 39 (38%) had previously received zoledronate. At baseline, albumin-corrected calcium levels were available for 48 patients (46.2%), and 70 (67.3%) were receiving calcium/vitamin D supplements. The median number of denosumab doses was 7.5 (range, 1-29). The main reasons for treatment discontinuation were disease progression (20.2%) and AE (25%). Hypocalcaemia was recorded in 38.5% of patients and osteonecrosis of the jaw in 12.5%. Monitoring of calcium levels was poor at baseline and during follow-up. Conclusions We found a higher incidence of all-grade osteonecrosis of the jaw than reported in the literature. Adherence to published recommendations on calcium supplementation and guidelines on calcium monitoring was poor. In line with our findings, a protocol for use and monitoring of denosumab has been promoted in our hospital.