Department of Haematology-Oncology, Royal Marsden Hospital, Downs Road, Surrey, UK.
Clin Transplant. 2011 Mar-Apr;25(2):222-7. doi: 10.1111/j.1399-0012.2010.01226.x.
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.
霉酚酸酯（MMF）用于治疗急性和慢性移植物抗宿主病（GvHD）。关于 GvHD 时霉酚酸（MPA）谷浓度监测的文献证据很少。因此，我们回顾了 32 例接受 MMF 治疗的急性（n = 19）或慢性 GvHD（n = 13）患者。19 例急性 GvHD 患者中有 12 例（63%）和 13 例慢性 GvHD 患者中有 9 例（69%）显示出良好的反应。在所有对 MMF 有反应的 21 例患者中，他们的平均总 MPA 水平是治疗性的（1-3.5mg/L），而在 11 例无反应的患者中有 5 例的平均 MPA 水平低于治疗范围（p = 0.002）。24 例类固醇难治性或依赖性患者中有 16 例（66%）对 MMF 有反应。每个患者的平均总 MPA 水平与相应的平均血清白蛋白浓度之间的关联显示，在所有 23 例平均白蛋白≥31g/L 的患者中，平均总 MPA 水平均为治疗性，但在 9 例平均白蛋白<31g/L 的患者中有 5 例为亚治疗性（p = 0.0006）。总之，MMF 在类固醇难治性和依赖性急性或慢性 GvHD 中有效，治疗性血浆总 MPA 谷浓度与临床反应之间存在统计学显著相关性。在考虑调整 MMF 剂量时，应考虑血清白蛋白水平。
