Journal
INTERNATIONAL JOURNAL OF HEMATOLOGY
Volume 110, Issue 3, Pages 355-363Publisher
SPRINGER JAPAN KK
DOI: 10.1007/s12185-019-02684-0
Keywords
Busulfan; Pharmacokinetics; Hematopoietic stem cell transplantation; Infant; KMT2A
Categories
Funding
- Ministry of Health, Labour and Welfare of Japan [H23-GanRinsho-Ippan-014, H26-GanRinsho-Shitei-068]
- Japan Agency for Medical Research and Development (AMED) [17ck0106382s0101, 18ck0106436h0001]
- National Center for Child Health and Development [30-1]
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Individual busulfan (BU) dosing based on pharmacokinetic (PK) data is preferable for hematopoietic stem cell transplantation (HSCT) conditioning, but information on BU PK in infants is scarce. We report BU PK data on HSCT conditioning for infants with KMT2A-gene-rearrangement-positive acute lymphoblastic leukemia (MLL-r ALL). Infants showed wide variation in BU PK indices, such as clearance (CL) and volume of distribution (V-d) value, which are distributed more widely among those who received oral, rather than intravenous (IV), BU. Because the steady state concentration (C-ss) fluctuates readily in infants, dose re-adjustment based on PK at the initial administration was important even if the initial dose was determined by a PK test. HSCT can be performed safely within the C-ss range of 600-900 ng/mL per dose, although it was difficult to fit within the therapeutic index of BU. The clinical outcome of engraftment, graft-versus-host disease, adverse events, including sinusoidal obstruction syndrome, and survival did not correlate with the BU PK data, which paradoxically suggests that remaining within this C-ss range helped minimize transplant-related toxicities, while securing engraftment in infants with MLL-r ALL.
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