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- Title
Optimal initial dose of oral cyclosporine in relation to its toxicities for graft-versus-host disease prophylaxis following reduced-intensity stem cell transplantation in Japanese patients.
- Authors
Kishi, Y.; Murashige, N.; Kami, M.; Miyakoshi, S.; Shibagaki, Y.; Hamaki, T.; Takaue, Y.; Taniguchi, S.
- Abstract
Summary:Since the introduction of reduced-intensity stem-cell transplantation (RIST), allogeneic stem-cell transplantation has become available for elderly patients. While pharmacokinetics of cyclosporine might differ according to age or other factors, cyclosporine is uniformly started at an oral dose of 6?mg/kg/day. We retrospectively reviewed medical records of 35 patients aged between 32 and 65 (median 52) years who had undergone RIST. Doses of cyclosporine were adjusted to the target blood trough level of 150-250?ng/ml. Cyclosporine dosages were changed in 33 patients (94%). Dose reduction was required in 32 patients because of high blood levels (n=25), renal dysfunction (n=3), hepatic dysfunction (n=2), and hypertension (n=2). Cyclosporine doses were increased in one because of the suboptimal level. The median of the achieved stable doses was 3.1?mg/kg/day (range, 1.0-7.4). Five patients sustained Grade III toxicities according to NCI-CTC version 2.0: renal dysfunction (n=4), hyperbilirubinemia (n=2), and hypertension (n=2). No patients developed grade IV toxicity. There was no statistically significant difference in the frequency and severity of cyclosporine toxicities between patients aged 50 years and above and those below 50 years. The initial oral cyclosporine dose of 6?mg/kg/day was unnecessarily high irrespective of age. The possible overdose of cyclosporine might have aggravated regimen-related toxicities.Bone Marrow Transplantation (2005) 35, 1079-1082. doi:10.1038/sj.bmt.1704960 Published online 4 April 2005
- Subjects
CYCLOSPORINE; STEM cell transplantation; PHARMACOKINETICS; CYCLIC peptides; IMMUNOSUPPRESSIVE agents; HYPERTENSION
- Publication
Bone Marrow Transplantation, 2005, Vol 35, Issue 11, p1079
- ISSN
0268-3369
- Publication type
Article
- DOI
10.1038/sj.bmt.1704960