We read with great interest the article by Al-Jammali and colleagues (June 2019 issue), which discussed the challenges associated with the use of anticoagulants for patients who have atrial fibrillation after starting treatment with ibrutinib. We believe that this topic is very timely, given the widespread use of ibrutinib in clinical practice; however, we would like to raise some concerns.
Kirollos S. Hanna, PharmD, BCPS, BCOP, Robert Mancini, PharmD, BCOP, Dave Wilson, PharmD, Dan Zuckerman, MD
Practical Issues for Pharmacists
Neutropenia is a common dose-limiting toxicity of myelosuppressive chemotherapy and exposes patients to life-threatening infections and treatment delays. Febrile neutropenia, a concerning complication of chemotherapy, is defined as neutropenia associated with an oral temperature of more than 38.5°C or 2 consecutive readings of more than 38.0°C for 2 hours and an absolute neutrophil count of <0.5 × 109/L, or a count that is expected to decrease to less than 0.5 × 109/L within 48 hours.
Venous thromboembolism (VTE) is a major complication of hematologic malignancies and is associated with significant morbidity and mortality. Patients with multiple myeloma are especially at risk for VTEs based on the underlying disease pathophysiology and the treatments used for this patient population, specifically immunomodulatory drugs (IMiDs). The risk for VTE among patients ranges from 26% to 67% for those with newly diagnosed multiple myeloma, and from 11% to 15% for patients with relapsed or refractory multiple myeloma. The use of IMiDs further increases the risk for thromboembolic complications, particularly within the first 6 months of therapy, although this risk decreases over time.
Whitney L. Pittman, PharmD, Christina Wern, PharmD, Ashley E. Glode, PharmD, BCOP
Biologic drugs play an important role in healthcare and represent $232 billion in global revenue. Biologic drugs represent 25% of the total global pharmaceutical market. The number of biologic drugs approved by the US Food and Drug Administration (FDA) continues to increase, with 12 biologic drugs included in the 46 new molecular entities approved by the FDA in 2017. In addition, 10 new biologics were approved by the FDA in 2018, 40% of which were for the treatment of cancer. Biologic drugs are an important therapeutic option for patients with cancer and are used for the treatment of malignancies as well as for supportive care management.