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Comparison of valproate and levetiracetam for the prevention of busulfan-induced seizures in hematopoietic stem cell transplantation

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Abstract

Anticonvulsant administration is the standard of care for prevention of busulfan-induced seizures (BIS) in hematopoietic stem cell transplantation (HSCT). While valproate interacts with other drugs, including carbapenem antibiotics, levetiracetam has no known clinically significant interactions. Only a few reports have discussed the use of levetiracetam for the prevention of BIS in HSCT recipients. This retrospective study aimed to evaluate the efficacy and safety of valproate and levetiracetam for BIS prophylaxis in adult HSCT recipients. We identified patients who received valproate or levetiracetam to prevent BIS at the National Cancer Center Hospital from December 2015 to November 2017. Ninety-one patients were analyzed (valproate group 45; levetiracetam group 46). No BIS occurred in either group. The pattern of anticonvulsant-related adverse events was similar in both groups, except for a higher incidence of rash in the valproate group. Carbapenem antibiotics were more frequently used in the levetiracetam group than in the valproate group. In conclusion, valproate and levetiracetam are effective and safe for the prophylaxis of BIS. Levetiracetam may be more useful in patients colonized with extended-spectrum beta-lactamase-producing bacteria due to its lack of any clinically significant drug–drug interactions.

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Authors and Affiliations

  1. Department of Pharmacy, National Cancer Center Hospital, Tokyo, Japan

    Toshihisa Nakashima, Keiichi Koido, Yukiko Nishibuchi, Hironobu Hashimoto & Hiroyuki Terakado

  2. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Takashi Tanaka, Ayumu Ito, Yoshihiro Inamoto, Saiko Kurosawa, Sung-Won Kim & Takahiro Fukuda

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  1. Toshihisa Nakashima
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  2. Takashi Tanaka
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Contributions

TN, TT, TF, and HT designed the study. TN and TT performed the statistical analysis. KK, YN, HH, AI, YI, SK, and SWK reviewed the results. All authors wrote and critically revised the manuscript for important intellectual content, and approved the manuscript for publication.

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Correspondence to Takashi Tanaka.

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Nakashima, T., Tanaka, T., Koido, K. et al. Comparison of valproate and levetiracetam for the prevention of busulfan-induced seizures in hematopoietic stem cell transplantation. Int J Hematol 109, 694–699 (2019). https://doi.org/10.1007/s12185-019-02637-7

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  • DOI: https://doi.org/10.1007/s12185-019-02637-7

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