Preparative regimen dosing for hematopoietic stem cell transplantation in patients with chronic hepatic impairment: analysis of the literature and recommendations.
Hematopoietic stem cell transplantation (HSCT) is a potentially life-saving therapy for patients with malignant and nonmalignant disease states. Transplant has been associated with high treatment-related morbidity and mortality, therefore limiting its usefulness in patients with baseline liver dysfunction. In the event that a patient with hepatic insufficiency is selected for HSCT, dosage adjustments may be considered; however, no reliable endogenous biomarkers can serve as a guide for adjustments. There is no clear standard or guideline for how to approach these patients, and most adjustments are made empirically on the basis of expert opinion. This article offers practical advice and outlines our personal approaches to provide dosing recommendations for commonly-used preparative agents in the setting of hepatic impairment with the aim to optimize dosing for this patient population.
Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
Megan N
MN
Bodge
Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
Kathryn A
KA
Culos
Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center and Veterans Affairs Medical Center, Nashville, Tennessee.
Syed Noman
SN
Haider
Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
Michael Scott
MS
Thompson
Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center and Veterans Affairs Medical Center, Nashville, Tennessee. Electronic address: Bipin.Savani@vanderbilt.edu.
Bipin N
BN
Savani
D004334:Drug Administration Schedule; D054796:Drug Dosage Calculations; D016903:Drug Monitoring; D017408:Guidelines as Topic; D006402:Hematologic Diseases / Q000150:complications / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000473:pathology / Q000628:therapy*; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D019172:Transplantation Conditioning / Q000379:methods*
D019653:Myeloablative Agonists
Dosing; Hematopoietic cell transplantation; Hepatic insufficiency; Preparative regimens