Abstract
Benefits of serial electrocardiographic (ECG) monitoring to detect QT prolongation in patients with hematological malignancies remain unclear. This retrospective, single-center, study evaluated 316 adult acute leukemia and high-risk MDS patients who received 11,775 patient-days of voriconazole prophylaxis during induction chemotherapy. Of these, 37 patients (16.2%) experienced QTc prolongation. Medications associated with QTc prolongation included furosemide, haloperidol, metronidazole, mirtazapine, prochlorperazine, and venlafaxine. Hypokalemia and hypomagnesemia were also significantly associated with QTc prolongation (HR 3.15; p =.003 and HR 6.47, p =.007, respectively). Management modifications due to QTc prolongation included discontinuation of QT prolonging medications (n = 25), more aggressive electrolyte repletion (n = 5), and enhanced ECG monitoring (n = 3). One patient with multiple QT prolonging factors experienced possible Torsades de Pointes. Overall mortality was 15% with no cardiac-related deaths. Serial ECG monitoring during induction chemotherapy can be tailored proportionally to QT-prolonging risk factors. Management should include aggressive electrolyte repletion and avoidance of concurrent QT prolonging medications.
| Original language | English (US) |
|---|---|
| Journal | Leukemia and Lymphoma |
| DOIs | |
| State | Published - Jan 1 2019 |
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Keywords
- antifungal
- cardiac arrhythmia
- infection prophylaxis
- QTc prolongation
- Voriconazole
ASJC Scopus subject areas
- Hematology
- Oncology
- Cancer Research
Cite this
QT prolongation in patients with acute leukemia or high-risk myelodysplastic syndrome prescribed antifungal prophylaxis during chemotherapy-induced neutropenia. / Barreto, Jason N.; Cullen, Michael W.; Mara, Kristin C.; Grove, Meagan E.; Sierzchulski, Amanda G.; Dahl, Nathan J.; Tosh, Pritish K.; Dierkhising, Ross A.; Patnaik, Mrinal M.; Ackerman, Michael J.
In: Leukemia and Lymphoma, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - QT prolongation in patients with acute leukemia or high-risk myelodysplastic syndrome prescribed antifungal prophylaxis during chemotherapy-induced neutropenia
AU - Barreto, Jason N.
AU - Cullen, Michael W.
AU - Mara, Kristin C.
AU - Grove, Meagan E.
AU - Sierzchulski, Amanda G.
AU - Dahl, Nathan J.
AU - Tosh, Pritish K.
AU - Dierkhising, Ross A.
AU - Patnaik, Mrinal M.
AU - Ackerman, Michael J.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Benefits of serial electrocardiographic (ECG) monitoring to detect QT prolongation in patients with hematological malignancies remain unclear. This retrospective, single-center, study evaluated 316 adult acute leukemia and high-risk MDS patients who received 11,775 patient-days of voriconazole prophylaxis during induction chemotherapy. Of these, 37 patients (16.2%) experienced QTc prolongation. Medications associated with QTc prolongation included furosemide, haloperidol, metronidazole, mirtazapine, prochlorperazine, and venlafaxine. Hypokalemia and hypomagnesemia were also significantly associated with QTc prolongation (HR 3.15; p =.003 and HR 6.47, p =.007, respectively). Management modifications due to QTc prolongation included discontinuation of QT prolonging medications (n = 25), more aggressive electrolyte repletion (n = 5), and enhanced ECG monitoring (n = 3). One patient with multiple QT prolonging factors experienced possible Torsades de Pointes. Overall mortality was 15% with no cardiac-related deaths. Serial ECG monitoring during induction chemotherapy can be tailored proportionally to QT-prolonging risk factors. Management should include aggressive electrolyte repletion and avoidance of concurrent QT prolonging medications.
AB - Benefits of serial electrocardiographic (ECG) monitoring to detect QT prolongation in patients with hematological malignancies remain unclear. This retrospective, single-center, study evaluated 316 adult acute leukemia and high-risk MDS patients who received 11,775 patient-days of voriconazole prophylaxis during induction chemotherapy. Of these, 37 patients (16.2%) experienced QTc prolongation. Medications associated with QTc prolongation included furosemide, haloperidol, metronidazole, mirtazapine, prochlorperazine, and venlafaxine. Hypokalemia and hypomagnesemia were also significantly associated with QTc prolongation (HR 3.15; p =.003 and HR 6.47, p =.007, respectively). Management modifications due to QTc prolongation included discontinuation of QT prolonging medications (n = 25), more aggressive electrolyte repletion (n = 5), and enhanced ECG monitoring (n = 3). One patient with multiple QT prolonging factors experienced possible Torsades de Pointes. Overall mortality was 15% with no cardiac-related deaths. Serial ECG monitoring during induction chemotherapy can be tailored proportionally to QT-prolonging risk factors. Management should include aggressive electrolyte repletion and avoidance of concurrent QT prolonging medications.
KW - antifungal
KW - cardiac arrhythmia
KW - infection prophylaxis
KW - QTc prolongation
KW - Voriconazole
UR - http://www.scopus.com/inward/record.url?scp=85068889115&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068889115&partnerID=8YFLogxK
U2 - 10.1080/10428194.2019.1639165
DO - 10.1080/10428194.2019.1639165
M3 - Article
AN - SCOPUS:85068889115
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
SN - 1042-8194
ER -