Farhan Shatha, Bazydlo Michael, Neme Klodiana, Mikulandric Nancy, Peres Edward, Janakiraman Nalini
Stem Cell Transplant Program, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
Division of Biostatistics, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA.
Adv Hematol. 2017;2017:8690416. doi: 10.1155/2017/8690416. Epub 2017 Nov 8.
In the era of precision medicine, the impact of personalized dosing of busulfan is not clear. We undertook a retrospective analysis of 78 patients with myeloid malignancies who received fludarabine and busulfan (FluBu4) with or without measuring Bu pharmacokinetics (Bu PK) and those who received busulfan with cyclophosphamide (BuCy). Fifty-five patients received FluBu4, of whom 21 had Bu PK measured, and 23 patients received BuCy. Total donor cell chimerism showed that the percentage of patients maintaining 100% donor chimerism on day 100 was 66.7%, 38.2%, and 73.9% in the FluBu4 with PK, FluBu4 with no PK, and BuCy, respectively ( = .001). Patients who had decreasing donor chimerism by day 100 were 23.8%, 52.9%, and 26.1% in the FluBu4 with PK, FluBu4 with no PK, and BuCy, respectively ( = .04). Bu PK group had fewer patients with less than 95% donor chimerism on day 30, which was not statistically significant, 5% (FluBu4 PK), 31% (FluBu4 with no PK), and 21% (BuCy) ( = .18). Survival distributions were not statistically significant ( = .11). Thus, personalized drug dosing can impact donor chimerism in myeloid malignancies. This will need to be examined in larger retrospective multicenter studies and prospective clinical trials.
在精准医学时代，白消安个体化给药的影响尚不清楚。我们对78例接受氟达拉滨和白消安（FluBu4）治疗（无论是否测定白消安药代动力学（Bu PK））以及接受白消安联合环磷酰胺（BuCy）治疗的髓系恶性肿瘤患者进行了回顾性分析。55例患者接受FluBu4治疗，其中21例测定了Bu PK，23例患者接受BuCy治疗。总体供体细胞嵌合率显示，在第100天时维持100%供体嵌合率的患者百分比在测定PK的FluBu4组、未测定PK的FluBu4组和BuCy组中分别为66.7%、38.2%和73.9%（P = .001）。在第100天时供体嵌合率下降的患者在测定PK的FluBu4组、未测定PK的FluBu4组和BuCy组中分别为23.8%、52.9%和26.1%（P = .04）。在第30天时供体嵌合率低于95%的患者在Bu PK组较少，但差异无统计学意义，分别为5%（FluBu4 PK）、31%（未测定PK的FluBu4）和
