Nodomi Seishiro, Umeda Katsutsugu, Matsubara Hiroshi, Daifu Tomoo, Kato Itaru, Hiramatsu Hidefumi, Watanabe Ken-ichiro, Heike Toshio, Adachi Souichi
Department of Pediatrics, Kyoto University, Kyoto, Japan.
Rinsho Ketsueki. 2012 Nov;53(11):1891-7.
Cyclosporine (CsA) is widely used for graft-versus-host disease (GVHD) in pediatric hematopoietic stem cell transplantation (HSCT); however, the optimal schedule of its administration has not been established. We retrospectively compared the time-course of blood CsA levels and the incidence of CsA-associated adverse effects, grade II-IV acute GVHD, and chronic GVHD among 26 pediatric HSCT recipients who were receiving CsA by continuous infusion (CIF) (n=8) or by 3h infusion twice-daily (3TD) (n=18). In the 3TD group, the target level of the C3 value, which is strongly co-related with the area under the concentration-time curve, was maintained without any serious adverse effects in most patients. No significant differences were observed in the incidence of grade II-IV acute GVHD and chronic GVHD between CIF and 3TD groups. 3TD in combination with C3 monitoring enables safe and easy control of CsA blood levels and is thought to be useful for GVHD prophylaxis in pediatric HSCT.
环孢素(CsA)在儿科造血干细胞移植(HSCT)中广泛用于移植物抗宿主病(GVHD);然而,其最佳给药方案尚未确定。我们回顾性比较了26例接受持续输注(CIF)(n = 8)或每日两次3小时输注(3TD)(n = 18)环孢素的儿科HSCT受者的血中环孢素水平的时间进程以及环孢素相关不良反应、II-IV级急性GVHD和慢性GVHD的发生率。在3TD组中,与浓度-时间曲线下面积密切相关的C3值的目标水平在大多数患者中得以维持,且无任何严重不良反应。CIF组和3TD组之间在II-IV级急性GVHD和慢性GVHD的发生率方面未观察到显著差异。3TD联合C3监测能够安全、简便地控制环孢素血药水平,被认为对儿科HSCT的GVHD预防有用。