Cyclosporine monitoring in allogeneic bone marrow transplantation

Abstract

Objective. To review the benefits and limitations of cyclosporine concentration monitoring to maximize efficacy of graft-versus-host disease prophylaxis and minimize risk of cyclosporine toxicity. Data Sources. A CANCERLIT search of articles published from 1980 to 1995, using the MESH head ings "cyclosporine," and "bone marrow transplant." References listed in the identified publications were reviewed for additional pertinent literature. Study Selection. Human clinical trials and re view articles evaluating cyclosporine pharmacokinet ics and pharmacodynamics in patients status follow ing bone marrow transplantation. Data synthesis. Cyclosporine concentration monitoring has been proposed due to the critical need for drug efficacy, substanial drug-induced toxic ity, and high pharmacokinetic variability. Selection of biological fluid (blood, serum, or plasma) for moni toring as well as the selectivity of the assay employed for cyclosporine versus its metabolites, is a critical factor in evaluating this literature. Both the relation ship between cyclosporine trough concentration and clinical outcome has been evaluated in this patient population. Conclusions. Cyclosporine trough concentra tion monitoring, especially in the blood using an assay specific for the parent compound, has a role in the care of the allogeneic bone marrow transplantation patient. Cyclosporine levels have been correlated with risk for nephrotoxicity and to a lesser extent hepatotoxicity. Low cyclosporine levels are one fac tor contributing to the risk for acute graft-versus-host disease in these patients. Proper evaluation of cyclo sporine levels with due consideration to patient spe cific factors can assist the clinician in maximizing the chances for graft-versus-host disease prevention while reducing the risk of cyclosporine side effects.