Augmented Renal Clearance of Vancomycin in Hematologic Malignancy Patients

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  • Izumisawa Tomohiro
    Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
  • Kaneko Tomoyoshi
    Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
  • Soma Masakazu
    Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
  • Imai Masahiko
    Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University
  • Wakui Nobuyuki
    Division of Applied Pharmaceutical Education and Research, Hoshi University
  • Hasegawa Hideo
    Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
  • Horino Tetsuya
    Department of Infectious Diseases and Infection Control, Jikei University School of Medicine
  • Takahashi Noriko
    Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University

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<p>The pharmacokinetics of vancomycin (VAN) was retrospectively examined based on trough concentrations at large scale to identify pharmacokinetic differences between Japanese hematologic malignancy and non-malignancy patients. Data from 261 hematologic malignancy patients and 261 non-malignancy patients, including the patient’s background, VAN dose, and pharmacokinetics of VAN estimated by an empirical Bayesian method, were collected and analyzed. Our results showed significantly higher values for VAN clearance and shorter elimination half-lives in patients with hematologic malignancies than non-malignancy patients. In addition, multiple regression analysis under adjusting for confounding factors by propensity score, showed that VAN clearance significantly increased in relation to hematologic malignancies. In conclusion, since in hematologic cancer patients VAN clearance is increased, the blood concentration of VAN becomes lower than expected and this may contribute to the survival of resistant bacteria when VAN is administered at low doses. These results suggest that early monitoring of VAN levels in hematologic cancer patients might be recommended to maintain desired effects without side-effects.</p>

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