Adjustments to pharmacologic therapies for hemophagocytic lymphohistiocytosis while on extracorporeal support.

Hemophagocytic lymphohistiocytosis (HLH) is an immune dysregulatory syndrome characterized by severe inflammation and end-organ damage. Due to significant organ dysfunction, patients often require extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). In this report, we describe consideration for adjusting treatment in the context of extracorporeal organ support. We describe agents commonly used and dosing adjustments made in light of extracorporeal organ support. We report six cases that illustrate the feasibility of initiating standard HLH therapies in patients requiring these modalities.

Treatment of dyslipidemia in allogeneic hematopoietic stem cell transplant patients.

As survival rates in allogeneic hematopoietic stem cell transplantation (HSCT) continue to improve, attention to long-term complications, including cardiovascular disease, becomes a major concern. Cardiovascular disease and dyslipidemia are a common, yet often overlooked occurrence post-HSCT that results in significant morbidity and mortality. Also, increasing evidence shows that several anti-hyperlipidemia medications, the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors in particular, may have a role in modulating graft-versus-host disease (GVHD). However, factors such as drug-drug interactions, adverse effect profiles, and the relative efficacy in lowering cholesterol and triglyceride levels must be taken into account when choosing safe and effective lipid-lowering therapy in this setting. This review seeks to provide guidance to the clinician in the management of dyslipidemia in the allogeneic HSCT population, taking into account the recently published American College of Cardiology/American Heart Association guidelines on hyperlipidemia management, special considerations in this challenging population, and the evidence for each agent's potential role in modulating GVHD.

Best practice management of CINV in oncology patients: I. Physiology and treatment of CINV. Multiple neurotransmitters and receptors and the need for combination therapeutic approaches.

Chemotherapy-induced nausea and vomiting (CINV) involves multiple neurotransmitter and receptor systems; thus, its optimal treatment is likely to require a combination of therapies targeting multiple systems. Antiemetic regimens have evolved from use of dopamine antagonists alone to combination regimens such as a corticosteroid plus an antagonist of the serotonin (5-hydroxytryptamine) type 3 receptor or this combination with a neurokinin-1 receptor antagonist. The net result is that antiemetic efficacy has markedly increased with the addition of each new class of agent to treatment regimens. Further research is needed to determine optimal uses of available classes and agents for managing CINV, to elucidate the roles of additional neurotransmitters and receptors in both nausea and vomiting, and to develop new antiemetic agents.