Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, USA.
Biol Blood Marrow Transplant. 2012 Jul;18(7):989-1006. doi: 10.1016/j.bbmt.2011.11.029. Epub 2011 Dec 7.
Morbidity is increased in patients undergoing hematopoietic stem cell transplantation when drug-drug interactions lead to unexpected outcomes. These interactions occur as a result of exposure to complicated medical regimens with drugs with narrow therapeutic windows and high toxicity profiles. In this report, we review the available evidence and possible mechanisms of the most clinically relevant drug interactions, including those involving inhibitors and inducers of the P450 isoenzyme system. We identify key interactions that should be familiar to any physician caring for patients after hematopoietic stem cell transplantation. We discuss drug metabolism in children and in the elderly and examine how age-related differences in metabolism make complicate drug regimens in these populations. A better understanding of these interactions and the responsible mechanisms will promote efficient delivery of the safest medical regimens to patients undergoing hematopoietic stem cell transplantation.
当药物-药物相互作用导致意外结果时，接受造血干细胞移植的患者的发病率会增加。这些相互作用是由于接触到具有狭窄治疗窗和高毒性特征的复杂药物治疗方案而产生的。在本报告中，我们回顾了最具临床相关性的药物相互作用的现有证据和可能机制，包括涉及 P450 同工酶系统抑制剂和诱导剂的相互作用。我们确定了任何照顾造血干细胞移植后患者的医生都应该熟悉的关键相互作用。我们讨论了儿童和老年人的药物代谢，并研究了年龄相关的代谢差异如何使这些人群的药物治疗方案复杂化。更好地了解这些相互作用及其负责的机制将促进向接受造血干细胞移植的患者提供最安全的药物治疗方案。
