title: Assessment of cyclosporine serum concentrations on the incidence of acute graft versus host disease post hematopoietic stem cell transplantation.
abstract: Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment option for hematological disorders. Cyclosporine (CsA) is one of the major immunosuppressive agents for the prophylaxis against graft versus host disease (GvHD). In this retrospective study, we evaluated the effects of CsA serum levels on the incidence of acute GvHD and transplant outcomes. Retrospective study in 103 adult patients received Hematopoitic Stem Cell Transplantation (HSCT) in the Hematology-Oncology, Bone Marrow Transplantation center at Shariati Hospital in Tehran, Iran. All participants received prophylactic regimen of cyclosporine plus methotrexate. CsA dose titration was done according to patients᾽ serum levels and drug toxicity. Serum levels tested on the twice weekly basis in first 4 weeks after transplantation. Acute GvHD (grades II-IV) developed in 44 patients (43%, 95%CI: 33%-52%). The median time to ANC and PLT recovery was 13 days (range: 9-31 days) and 16 days (range: 0-38 days), respectively. Univariate analysis of risk factors related to aGvHD (grade II-IV) development showed a higher risk of incidence of aGvHD (grades II-IV) for patients having the lowest blood CSA concentration (<200 ng/mL) in the third weeks after transplantation (36% vs. 12%, P = 0.035). The only risk factors related to incidence of aGvHD grades III-IV was also blood CsA concentration at 3(rd) week post-transplant (15% vs. 3%, P = 0.047). The CsA concentration at 3(rd) week was not related to disease free survival and overall survival (P = 0.913 vs. P = 0.81) respectively. Higher CsA serum levels in the third week post HSCT significantly decreased incidence of acute GvHD.
authors.affiliation: Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sara
authors.initials: S
authors.lastname: Zeighami
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, and Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Molouk
authors.initials: M
authors.lastname: Hadjibabaie
authors.affiliation: Hematology-Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Asieh
authors.initials: A
authors.lastname: Ashouri
authors.affiliation: Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Sarayani
authors.affiliation: Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Hamid
authors.initials: SH
authors.lastname: Khoee
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, and Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mousavi
authors.affiliation: Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mania
authors.initials: M
authors.lastname: Radfar
authors.affiliation: Hematology-Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ardeshir
authors.initials: A
authors.lastname: Ghavamzadeh
keywords: Cyclosporine; Graft versus host disease; Hematopoietic stem cell transplant
references.citation: Clin Pharmacokinet. 1986 Mar-Apr;11(2):107-32
references.pmid: 3514043
references.citation: Transplantation. 1999 Dec 27;68(12):1839-42
references.pmid: 10628760
references.citation: Clin Pharmacokinet. 1997 Jun;32(6):481-95
references.pmid: 9195117
references.citation: Br J Haematol. 1997 Jun;97(4):855-64
references.pmid: 9217189
references.citation: Bone Marrow Transplant. 2003 Oct;32(8):777-84
references.pmid: 14520421
references.citation: N Engl J Med. 1989 Dec 21;321(25):1725-38
references.pmid: 2687689
references.citation: Blood. 1989 May 1;73(6):1729-34
references.pmid: 2653461
references.citation: N Engl J Med. 1988 Jul 14;319(2):65-70
references.pmid: 3288872
references.citation: Am J Hematol. 2006 Nov;81(11):838-44
references.pmid: 16888784
references.citation: Biol Blood Marrow Transplant. 2010 Jan;16(1):28-34
references.pmid: 20053329
references.citation: Am J Hematol. 2008 Mar;83(3):226-32
references.pmid: 17918253
references.citation: Transplantation. 1983 Jul;36(1):40-4
references.pmid: 6346614
references.citation: Bone Marrow Transplant. 1991 Jun;7(6):461-5
references.pmid: 1873593
references.citation: Iran J Kidney Dis. 2010 Apr;4(2):153-7
references.pmid: 20404428
references.citation: Transplantation. 2002 Mar 27;73(6):953-9
references.pmid: 11923699
references.citation: J Korean Med Sci. 2009 Aug;24(4):555-60
references.pmid: 19654932
references.citation: Cytokine Growth Factor Rev. 2008 Feb;19(1):53-63
references.pmid: 18083060
references.citation: Transplantation. 1985 Sep;40(3):249-53
references.pmid: 3898489
references.citation: Bone Marrow Transplant. 2003 Nov;32(9):881-7
references.pmid: 14561988
references.citation: Transplantation. 1974 Oct;18(4):295-304
references.pmid: 4153799
references.citation: Lancet. 1978 Dec 23-30;2(8104-5):1323-7
references.pmid: 82836
references.citation: Bone Marrow Transplant. 1987 Feb;1(3):289-95
references.pmid: 3332139
references.citation: Transplant Proc. 2004 Mar;36(2 Suppl):378S-391S
references.pmid: 15041372
references.citation: Biopharm Drug Dispos. 2012 Sep;33(6):324-31
references.pmid: 22890488