Pediatric Acute Lymphoblastic Leukemia Patients and Potential Risk for Vincristine Side Effects with Concomitant Fluconazole

Background: Pediatric Acute Lymphoblastic Leukemia (ALL) patients undergoing intensive treatment are considered at high risk for opportunistic infections. To prevent invasive fungal infection, some patients receive antifungal prophylaxis such as fluconazole. As a consequence, an increase in vincristine toxicity has been associated with the co-administration of antifungal prophylaxis. We analyzed whether the use of fluconazole prophylaxis impacts vincristine’s side effects during induction therapy. Method: We conducted a retrospective chart review of all pediatric (age 0-18 years) patients diagnosed with ALL at Children’s Hospital and Medical Center in Omaha, Nebraska from July 2013-May 2021. Patients were divided into two groups based on whether or not they received fluconazole. Incidence of fungal infection, rate and grade of peripheral neuropathy, and prescription for gabapentin (treatment for peripheral neuropathy) were collected for both groups. Results: We had 157 ALL patients, of which 72 patients received fluconazole, and 85 patients did not receive fluconazole. There was no significant difference between fluconazole use and increased incidence of peripheral neuropathy (p value= 0.28) or incidence of hyponatremia (p value =Conclusion: We did not find a statistically significant difference that the use of concomitant fluconazole with vincristine increased the risk of peripheral neuropathy or hyponatremia.https://digitalcommons.unmc.edu/surp2021/1037/thumbnail.jp

Vincristine Side Effects with Concomitant Fluconazole Use during Induction Chemotherapy in Pediatric Acute Lymphoblastic Leukemia

As a mainstay of treatment for acute lymphoblastic leukemia (ALL), vincristine’s side effect profile is well known. Parallel administration of the antifungal fluconazole has been shown to interfere with the metabolism of vincristine, potentially resulting in increased side effects. We conducted a retrospective chart review to determine whether concomitant administration of vincristine and fluconazole during pediatric ALL therapy impacted side effects of vincristine, namely, hyponatremia and peripheral neuropathy. We also evaluated whether the incidence of opportunistic fungal infections was impacted by fluconazole prophylaxis. Medical charts of all pediatric ALL patients treated with induction chemotherapy at Children’s Hospital and Medical Center in Omaha, NE from 2013-2021 were retrospectively reviewed. We found no correlation between fluconazole use and increased incidence of peripheral neuropathy or hyponatremia. Additionally, the rate of fungal infections was not impacted by fluconazole prophylaxis. Empiric fungal prophylaxis with fluconazole during pediatric ALL induction, although safe, may not be necessary.https://digitalcommons.unmc.edu/chri_forum/1039/thumbnail.jp

Omega-3 Long-Chain Polyunsaturated Fatty Acids Intake by Ethnicity, Income, and Education Level in the United States: NHANES 2003-201414.

Although there are many recognized health benefits for the consumption of omega-3 (n-3) long-chain polyunsaturated fatty acids (LCPUFA), intake in the United States remains below recommended amounts. This analysis was designed to provide an updated assessment of fish and n-3 LCPUFA intake (eicosapentaenoic (EPA), docosahexaenoic acid (DHA), and EPA+DHA) in the United States adult population, based on education, income, and race/ethnicity, using data from the 2003-2014 National Health and Nutrition Examination Survey (NHANES) (n = 44,585). Over this survey period, participants with less education and lower income had significantly lower n-3 LCPUFA intakes and fish intakes (p \u3c 0.001 for all between group comparisons). N-3 LCPUFA intake differed significantly according to ethnicity (p \u3c 0.001), with the highest intake of n-3 LCPUFA and fish in individuals in the Other category (including Asian Americans). Supplement use increased EPA + DHA intake, but only 7.4% of individuals consistently took supplements. Overall, n-3 LCPUFA intake in this study population was low, but our findings indicate that individuals with lower educational attainment and income are at even higher risk of lower n-3 LCPUFA and fish intake