Oral vancomycin for Clostridioides difficile prophylaxis in allogenic hematopoietic cell transplant.

BACKGROUND: Neutropenia and antibiotic use put patients at risk for Clostridioides difficile infection (CDI) following allogenic hematopoietic cell transplant (alloHCT). CDI following alloHCT has been associated with acute graft-versus-host disease (aGVHD), a significant cause of morbidity and mortality in this population. We sought to evaluate if prophylactic oral vancomycin reduces the incidence of CDI in alloHCT recipients. METHODS: We conducted a single-center retrospective chart review to compare the effectiveness of oral vancomycin prophylaxis versus no prophylaxis in alloHCT recipients at the University of Kansas Health System. Vancomycin for CDI prophylaxis was implemented in March of 2018 at the University of Kansas Health System. Review of 100 consecutive alloHCT patients before and after this implementation was used to compare outcomes. Patients received oral vancomycin 125 mg twice daily, starting on the day of inpatient admission for alloHCT and continued until discharge. The primary outcome is the incidence of CDI in patients with oral vancomycin prophylaxis compared to those who did not receive prophylaxis during hospital admission for alloHCT. The secondary endpoints include the incidence of acute grades 2-4 GVHD, and event-free survival for each arm. RESULTS: Eleven percent of patients developed CDI in the control group versus 2% of patients in the intervention group (p = .018). Oral vancomycin was not associated with a higher risk of acute GVHD grades 2-4 (36% vs. 38%; p = .77) at day 100 post transplant. No difference was seen in event-free survival. CONCLUSIONS: Oral vancomycin was associated with reduced CDI incidence in patients that underwent an alloHCT without negatively affecting posttransplant outcomes. The contribution of confounders cannot be excluded.

Effects of filgrastim versus pegfilgrastim on outcomes of DA-R-EPOCH for non-Hodgkin's lymphoma.

PURPOSE: Our study aimed to compare the median and average last dose level reached with DA-R-EPOCH, which includes the chemotherapy agents etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab, in patients using filgrastim versus pegfilgrastim as febrile neutropenia primary prophylaxis. METHODS: A retrospective, single-center chart review from January 1, 2014, to September 30, 2019, at The University of Kansas Health System identified patients > 18 years old who received at least four cycles of DA-R-EPOCH in an inpatient or outpatient setting for any subtype of lymphoma along with at least one dose of filgrastim or pegfilgrastim. Data was collected to compare dosing levels reached, appropriate discontinuation of daily filgrastim when ANC > 5000 cells/mm3, completion of at least twice weekly complete blood count (CBC) monitoring after chemotherapy administration, the incidence of infections, FN, hospitalizations from infections or FN, and bone pain. RESULTS: We hypothesized that patients receiving pegfilgrastim will achieve similar median and average dose levels of DA-EPOCH, event-free survival rates, overall response rates, completion of at least twice weekly CBC monitoring, and incidence of infections, FN, hospitalizations for infections or FN, and bone pain compared to patients receiving filgrastim. CONCLUSIONS: The use of pegfilgrastim as a supportive care agent resulted in similar efficacy and safety outcomes compared to filgrastim with DA-R-EPOCH in terms of dose intensity levels and incidence of infections, FN, and bone pain.