Conditioning chemotherapy dose adjustment in obese patients: a review and position statement by the American Society for Blood and Marrow Transplantation practice guideline committee.
Hematopoietic stem cell transplantation (HCT) is a potentially life-saving therapy for patients with malignant and nonmalignant disease states. This article reviews the current published literature on the dosing of pharmacologic agents used for HCT preparative regimens with specific focus on the obese patient population. The review found that dose adjustments for obesity have, to date, been based empirically or extrapolated from published data in the nontransplantation patient population. As a result, the Committee determined that clear standards or dosing guidelines are unable to be made for the obese population because Level I and II evidence are unavailable at this time. Instead, the Committee provides a current published literature review to serve as a platform for conditioning agent dose selection in the setting of obesity. A necessary goal should be to encourage future prospective trials in this patient population because further information is needed to enhance our knowledge of the pharmacokinetics and pharmacodynamics of conditioning agents in the setting of obesity.
Department of Pharmacy Services, Oregon Health and Science University Hospital, Portland, Oregon. Electronic address: bubaloj@ohsu.edu.
Joseph
J
Bubalo
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Paul A
PA
Carpenter
Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
Navneet
N
Majhail
Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
Miguel-Angel
MA
Perales
Bristol Bone Marrow Transplant Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
David I
DI
Marks
Adult Bone Marrow Transplant, Texas Transplant Institute, San Antonio, Texas.
Paul
P
Shaughnessy
Division of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida.
Joseph
J
Pidala
Division of Hematology/Oncology, University of Florida Health Cancer Center, Gainesville, Florida.
Helen L
HL
Leather
Division of Hematology/Oncology, University of Florida Health Cancer Center, Gainesville, Florida.
John
J
Wingard
Vanderbilt University Medical Center, Nashville, Tennessee.
Bipin N
BN
Savani
D006801:Humans; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002066:Busulfan / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D004334:Drug Administration Schedule; D054796:Drug Dosage Calculations; D005047:Etoposide / Q000627:therapeutic use; D006402:Hematologic Diseases / Q000150:complications / Q000473:pathology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D008558:Melphalan / Q000627:therapeutic use; D019653:Myeloablative Agonists / Q000627:therapeutic use; D009765:Obesity / Q000150:complications / Q000473:pathology / Q000628:therapy; D019172:Transplantation Conditioning
D000961:Antilymphocyte Serum; D002066:Busulfan; D003520:Cyclophosphamide; D003561:Cytarabine; D005047:Etoposide; D008558:Melphalan; D019653:Myeloablative Agonists
Dosing; Hematopoietic cell transplantation; Obesity; Preparative regimens