Daily Electrolyte Replacement and the Impact on Count Recovery in Autologous Hematopoietic Stem Cell Transplantation

Abstract

Introduction/Objectives Engraftment is an important milestone following hematopoietic stem cell transplantation (HSCT) and delays in this process can put patients at risk for complications such as infection. This cell recovery process is mediated in part by the electrolytes magnesium, phosphorus, and potassium, which function as building blocks for cellular components and metabolic processes. Due to the role of electrolytes in cell synthesis, this study aims to evaluate the impact of aggressive electrolyte replacement on time to neutrophil engraftment, in patients receiving autologous HSCT. Secondary endpoints being evaluated include length of hospitalization and incidence of complications following HSCT. Methods This was a two-cohort study comparing electrolyte replacement practice prior to and after the implementation of a pharmacist-driven electrolyte replacement protocol. We assessed the impact of daily electrolyte monitoring and prophylactic electrolyte replacement on neutrophil engraftment. The retrospective cohort consisted of 100 patients who had received an autologous HSCT at our center. The prospective cohort will be comprised of 100 patients with patient accrual ongoing. Patients enrolled in the prospective cohort received daily oral supplementation of potassium, phosphorus, and magnesium with labs drawn daily and additional intravenous electrolyte replacement given per protocol. Results 19 subjects have been treated. Oral electrolyte supplementation has been well tolerated and intravenous supplementation has been reduced with the use of empiric oral supplementation. Mean number of days to engraftment in the retrospective cohort was 11.1 (95%CI [10.8-11.4]), while the mean number of days in the current prospective cohort is 11.4 (95%CI [11.0-11.8]). A full interim analysis is planned after 50 subjects have been treated per protocol, which is expected by January or February, 2020. Conclusion Aggressive electrolyte replacement following autologous HSCT at this point does not seem to have a significant impact on time to engraftment, but does seem to lower the need for intravenous electrolyte replacement. Further conclusions will depend on the results of ongoing study.