title: Mycophenolic acid trough level monitoring: relevance in acute and chronic graft versus host disease and its relation with albumin.
abstract: Mycophenolate mofetil (MMF) is used to treat acute and chronic graft versus host disease (GvHD). There is scant evidence in the literature about mycophenolic acid (MPA) trough level monitoring in GvHD. We therefore reviewed 32 patients treated with MMF for acute (n = 19) or chronic GvHD (n = 13). Twelve (63%) of 19 patients with acute GvHD and nine (69%) of 13 with chronic GvHD showed a good response. In all 21 patients who responded to MMF, their mean total MPA levels were therapeutic (1-3.5 mg/L), whereas five of 11 patients who did not respond had sub-therapeutic mean MPA levels (p = 0.002). Sixteen (66%) of 24 steroid refractory or dependent patients responded to MMF. Associations between the mean total MPA level for each patient and the corresponding mean serum albumin concentration showed therapeutic mean total MPA levels for all 23 patients with mean albumin ≥ 31 g/L but sub-therapeutic mean total MPA levels in five of nine patients with mean albumin <31 g/L (p = 0.0006). In conclusion, MMF is efficacious in steroid refractory and dependent acute or chronic GvHD with statistically significant correlation between therapeutic plasma total MPA trough levels and clinical response. Serum albumin levels should be taken into account when considering MMF dose adjustments.
authors.affiliation: Department of Haematology-Oncology, Royal Marsden Hospital, Downs Road, Surrey, UK. drhprashant@doctors.net.uk
authors.forename: P
authors.initials: P
authors.lastname: Hiwarkar
authors.forename: B E
authors.initials: BE
authors.lastname: Shaw
authors.forename: J M
authors.initials: JM
authors.lastname: Tredger
authors.forename: N W
authors.initials: NW
authors.lastname: Brown
authors.forename: S
authors.initials: S
authors.lastname: Kulkarni
authors.forename: R
authors.initials: R
authors.lastname: Saso
authors.forename: S
authors.initials: S
authors.lastname: Evans
authors.forename: J
authors.initials: J
authors.lastname: Treleaven
authors.forename: F E
authors.initials: FE
authors.lastname: Davies
authors.forename: M E
authors.initials: ME
authors.lastname: Ethell
authors.forename: G J
authors.initials: GJ
authors.lastname: Morgan
authors.forename: M N
authors.initials: MN
authors.lastname: Potter
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000418:Albumins / Q000032:analysis*; D000903:Antibiotics, Antineoplastic / Q000097:blood / Q000493:pharmacokinetics*; D019540:Area Under Curve; D002908:Chronic Disease; D016903:Drug Monitoring; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000097:blood / Q000493:pharmacokinetics*; D014018:Tissue Distribution; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000418:Albumins; D000903:Antibiotics, Antineoplastic; D009173:Mycophenolic Acid