동종 조혈모세포 이식 성인 환자에서 cyclosporine clearance에 영향을 미치는 요인
Factors influencing the cyclosporine clearance in allergenic hematopoietic cell transplant recipients
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Cyclosporine(CsA) has been the most extensively used immunosuppressive agent to prevent or treat graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation( HCT). Since the severity of adverse reaction and pharmacokinetic complexity of CsA, maintaining optimal therapeutic CsA blood concentration is necessary to promote engraftment and to avoid toxicities. Unfortunately, there are few reports that have evaluated the correlation between CsA pharmacokinetics and dose adjustment in HCT. Therefore the objective of this study is to evaluate the factors that alter the clearance of CsA in HCT recipients. This study was conducted to 47 patients who underwent allogeneic HCT in Asan Medical Center during January 2004 ~ June 2006. We retrospectively analyzed the factors of each patients during 60 days after HCT. The clearance of CsA was evaluated by using cKin 1.1. Then we evaluated the correlation between clearance and factors using SPSS. The mean clearance of CsA was 0.49±0.15 L/hr/kg (mean±SD). Experience of veno-occlusive disease and total bilirubin (t-bil) level was significantly disproportionated to CsA clearance (P=0.012 and P=0.016). In multivariate analysis, total bilirubin level was the most significant factor to decrease CsA clearance (P=0.008). The Influence of elevated t-bil to CsA clearance suggests that close monitoring of CsA blood level in hepatic dysfunction patients is required to obtain optimal therapeutic outcome
Abstract
Cyclosporine(CsA) has been the most extensively used immunosuppressive agent to prevent or treat graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation( HCT). Since the severity of adverse reaction and pharmacokinetic complexity of CsA, maintaining optimal therapeutic CsA blood concentration is necessary to promote engraftment and to avoid toxicities. Unfortunately, there are few reports that have evaluated the correlation between CsA pharmacokinetics and dose adjustment in HCT. Therefore the objective of this study is to evaluate the factors that alter the clearance of CsA in HCT recipients. This study was conducted to 47 patients who underwent allogeneic HCT in Asan Medical Center during January 2004 ~ June 2006. We retrospectively analyzed the factors of each patients during 60 days after HCT. The clearance of CsA was evaluated by using cKin 1.1. Then we evaluated the correlation between clearance and factors using SPSS. The mean clearance of CsA was 0.49±0.15 L/hr/kg (mean±SD). Experience of veno-occlusive disease and total bilirubin (t-bil) level was significantly disproportionated to CsA clearance (P=0.012 and P=0.016). In multivariate analysis, total bilirubin level was the most significant factor to decrease CsA clearance (P=0.008). The Influence of elevated t-bil to CsA clearance suggests that close monitoring of CsA blood level in hepatic dysfunction patients is required to obtain optimal therapeutic outcome