Voriconazole exposure and the risk of cutaneous squamous cell carcinoma in allogeneic hematopoietic stem cell transplant patients

D. J. Wojenski, G. T. Bartoo, J. A. Merten, R. A. Dierkhising, M. R. Barajas, R. A. el-Azhary, J. W. Wilson, M. F. Plevak, William Hogan, Mark R Litzow, Mrinal M Patnaik, R. C. Wolf, S. K. Hashmi

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Voriconazole is a commonly used antifungal medication in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients. In solid organ transplantation, voriconazole use has been associated with the development of cutaneous squamous cell carcinoma (SCC). We sought to determine if voriconazole use was associated with SCC in patients undergoing allo-HSCT. Methods: We retrospectively reviewed consecutive adult patients who underwent allo-HSCT at Mayo Clinic from January 2007 through July 2012. Multivariable Cox models were created to assess the relationship of SCC with two time-dependent voriconazole exposure variables: (i) history of voriconazole exposure (yes/no), and (ii) cumulative days of voriconazole use. Results: In our cohort of 381 allo-HSCT patients, SCC developed in 26 of 312 patients exposed to voriconazole (25 post-voriconazole) and in 1 of 69 patients who received alternative antifungal agent(s). Cumulative incidence of SCC was estimated to be 19% at 5 years post allo-transplant. Cumulative days of voriconazole use was found to be a risk factor for SCC, and this relationship persisted in a multivariable model using previously identified risk factors as covariates (hazard ratio 1.859 for each 180 days of use, P < 0.001). Conclusion: This is the first study, to our knowledge, to identify cumulative days of voriconazole use as a risk factor for SCC development following allo-HSCT, and may help guide appropriate antifungal use in this patient population.

Original languageEnglish (US)
Pages (from-to)250-258
Number of pages9
JournalTransplant Infectious Disease
Volume17
Issue number2
DOIs
StatePublished - Apr 1 2015

Fingerprint

Hematopoietic Stem Cells
Squamous Cell Carcinoma
Transplants
Skin
Hematopoietic Stem Cell Transplantation
Voriconazole
Antifungal Agents
Organ Transplantation
Proportional Hazards Models
Incidence

Keywords

  • Cutaneous squamous cell carcinoma
  • Hematopoietic stem cell transplantation
  • Immunocompromised host
  • Triazole adverse effects
  • Voriconazole

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases
  • Medicine(all)

Cite this

Wojenski, D. J., Bartoo, G. T., Merten, J. A., Dierkhising, R. A., Barajas, M. R., el-Azhary, R. A., ... Hashmi, S. K. (2015). Voriconazole exposure and the risk of cutaneous squamous cell carcinoma in allogeneic hematopoietic stem cell transplant patients. Transplant Infectious Disease, 17(2), 250-258. https://doi.org/10.1111/tid.12367

Voriconazole exposure and the risk of cutaneous squamous cell carcinoma in allogeneic hematopoietic stem cell transplant patients. / Wojenski, D. J.; Bartoo, G. T.; Merten, J. A.; Dierkhising, R. A.; Barajas, M. R.; el-Azhary, R. A.; Wilson, J. W.; Plevak, M. F.; Hogan, William; Litzow, Mark R; Patnaik, Mrinal M; Wolf, R. C.; Hashmi, S. K.

In: Transplant Infectious Disease, Vol. 17, No. 2, 01.04.2015, p. 250-258.

Research output: Contribution to journalArticle

Wojenski, DJ, Bartoo, GT, Merten, JA, Dierkhising, RA, Barajas, MR, el-Azhary, RA, Wilson, JW, Plevak, MF, Hogan, W, Litzow, MR, Patnaik, MM, Wolf, RC & Hashmi, SK 2015, 'Voriconazole exposure and the risk of cutaneous squamous cell carcinoma in allogeneic hematopoietic stem cell transplant patients', Transplant Infectious Disease, vol. 17, no. 2, pp. 250-258. https://doi.org/10.1111/tid.12367
Wojenski, D. J. ; Bartoo, G. T. ; Merten, J. A. ; Dierkhising, R. A. ; Barajas, M. R. ; el-Azhary, R. A. ; Wilson, J. W. ; Plevak, M. F. ; Hogan, William ; Litzow, Mark R ; Patnaik, Mrinal M ; Wolf, R. C. ; Hashmi, S. K. / Voriconazole exposure and the risk of cutaneous squamous cell carcinoma in allogeneic hematopoietic stem cell transplant patients. In: Transplant Infectious Disease. 2015 ; Vol. 17, No. 2. pp. 250-258.
@article{332d1ec856064d5f8fa3a7a552750679,
title = "Voriconazole exposure and the risk of cutaneous squamous cell carcinoma in allogeneic hematopoietic stem cell transplant patients",
abstract = "Background: Voriconazole is a commonly used antifungal medication in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients. In solid organ transplantation, voriconazole use has been associated with the development of cutaneous squamous cell carcinoma (SCC). We sought to determine if voriconazole use was associated with SCC in patients undergoing allo-HSCT. Methods: We retrospectively reviewed consecutive adult patients who underwent allo-HSCT at Mayo Clinic from January 2007 through July 2012. Multivariable Cox models were created to assess the relationship of SCC with two time-dependent voriconazole exposure variables: (i) history of voriconazole exposure (yes/no), and (ii) cumulative days of voriconazole use. Results: In our cohort of 381 allo-HSCT patients, SCC developed in 26 of 312 patients exposed to voriconazole (25 post-voriconazole) and in 1 of 69 patients who received alternative antifungal agent(s). Cumulative incidence of SCC was estimated to be 19{\%} at 5 years post allo-transplant. Cumulative days of voriconazole use was found to be a risk factor for SCC, and this relationship persisted in a multivariable model using previously identified risk factors as covariates (hazard ratio 1.859 for each 180 days of use, P < 0.001). Conclusion: This is the first study, to our knowledge, to identify cumulative days of voriconazole use as a risk factor for SCC development following allo-HSCT, and may help guide appropriate antifungal use in this patient population.",
keywords = "Cutaneous squamous cell carcinoma, Hematopoietic stem cell transplantation, Immunocompromised host, Triazole adverse effects, Voriconazole",
author = "Wojenski, {D. J.} and Bartoo, {G. T.} and Merten, {J. A.} and Dierkhising, {R. A.} and Barajas, {M. R.} and el-Azhary, {R. A.} and Wilson, {J. W.} and Plevak, {M. F.} and William Hogan and Litzow, {Mark R} and Patnaik, {Mrinal M} and Wolf, {R. C.} and Hashmi, {S. K.}",
year = "2015",
month = "4",
day = "1",
doi = "10.1111/tid.12367",
language = "English (US)",
volume = "17",
pages = "250--258",
journal = "Transplant Infectious Disease",
issn = "1398-2273",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Voriconazole exposure and the risk of cutaneous squamous cell carcinoma in allogeneic hematopoietic stem cell transplant patients

AU - Wojenski, D. J.

AU - Bartoo, G. T.

AU - Merten, J. A.

AU - Dierkhising, R. A.

AU - Barajas, M. R.

AU - el-Azhary, R. A.

AU - Wilson, J. W.

AU - Plevak, M. F.

AU - Hogan, William

AU - Litzow, Mark R

AU - Patnaik, Mrinal M

AU - Wolf, R. C.

AU - Hashmi, S. K.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Background: Voriconazole is a commonly used antifungal medication in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients. In solid organ transplantation, voriconazole use has been associated with the development of cutaneous squamous cell carcinoma (SCC). We sought to determine if voriconazole use was associated with SCC in patients undergoing allo-HSCT. Methods: We retrospectively reviewed consecutive adult patients who underwent allo-HSCT at Mayo Clinic from January 2007 through July 2012. Multivariable Cox models were created to assess the relationship of SCC with two time-dependent voriconazole exposure variables: (i) history of voriconazole exposure (yes/no), and (ii) cumulative days of voriconazole use. Results: In our cohort of 381 allo-HSCT patients, SCC developed in 26 of 312 patients exposed to voriconazole (25 post-voriconazole) and in 1 of 69 patients who received alternative antifungal agent(s). Cumulative incidence of SCC was estimated to be 19% at 5 years post allo-transplant. Cumulative days of voriconazole use was found to be a risk factor for SCC, and this relationship persisted in a multivariable model using previously identified risk factors as covariates (hazard ratio 1.859 for each 180 days of use, P < 0.001). Conclusion: This is the first study, to our knowledge, to identify cumulative days of voriconazole use as a risk factor for SCC development following allo-HSCT, and may help guide appropriate antifungal use in this patient population.

AB - Background: Voriconazole is a commonly used antifungal medication in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients. In solid organ transplantation, voriconazole use has been associated with the development of cutaneous squamous cell carcinoma (SCC). We sought to determine if voriconazole use was associated with SCC in patients undergoing allo-HSCT. Methods: We retrospectively reviewed consecutive adult patients who underwent allo-HSCT at Mayo Clinic from January 2007 through July 2012. Multivariable Cox models were created to assess the relationship of SCC with two time-dependent voriconazole exposure variables: (i) history of voriconazole exposure (yes/no), and (ii) cumulative days of voriconazole use. Results: In our cohort of 381 allo-HSCT patients, SCC developed in 26 of 312 patients exposed to voriconazole (25 post-voriconazole) and in 1 of 69 patients who received alternative antifungal agent(s). Cumulative incidence of SCC was estimated to be 19% at 5 years post allo-transplant. Cumulative days of voriconazole use was found to be a risk factor for SCC, and this relationship persisted in a multivariable model using previously identified risk factors as covariates (hazard ratio 1.859 for each 180 days of use, P < 0.001). Conclusion: This is the first study, to our knowledge, to identify cumulative days of voriconazole use as a risk factor for SCC development following allo-HSCT, and may help guide appropriate antifungal use in this patient population.

KW - Cutaneous squamous cell carcinoma

KW - Hematopoietic stem cell transplantation

KW - Immunocompromised host

KW - Triazole adverse effects

KW - Voriconazole

UR - http://www.scopus.com/inward/record.url?scp=84925359586&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84925359586&partnerID=8YFLogxK

U2 - 10.1111/tid.12367

DO - 10.1111/tid.12367

M3 - Article

VL - 17

SP - 250

EP - 258

JO - Transplant Infectious Disease

JF - Transplant Infectious Disease

SN - 1398-2273

IS - 2

ER -