Nueclear Web Banner
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
Ahead of Print

Analysis of factors affecting initial cyclosporine level and its impact on post transplant outcomes in acute leukemia

1 Department of Medical Oncology, Bone Marrow Transplant Unit, Maharashtra, India
2 Biostatistics, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Mumbai, Maharashtra, India

Correspondence Address:
Navin Khattry,
Department of Medical Oncology, Bone Marrow Transplant Unit, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Mumbai - 410 210, Maharashtra
Login to access the Email id

Source of Support: None, Conflict of Interest: None

Background: Trough cyclosporine (CsA) blood level can influence incidence of graft-versus-host disease (GVHD) and relapse in patients with acute leukemia undergoing allogeneic hematopoietic stem cell transplant (HSCT). We sought to determine factors affecting initial trough CsA level (CsA-1) and its impact on transplant outcome in acute leukemia. Materials and Methods: Seventy-seven patients underwent HSCT for acute leukemia between January 2008 and March 2013 and were included. GVHD prophylaxis included CsA + methotrexate (MTX) in 53 patients and CsA + mycophenolate mofetil (MMF) in 24 patients. CsA-1 was measured on day 3-5 of starting CsA and subsequent dose was modified to achieve therapeutic level of 150-200 ng/mL. According to CsA-1, patients were divided into three groups - 27 in Group A (dose escalated), 13 in Group B (dose de-escalated), and 37 in Group C (same dose continued). Results: On univariate analysis, cyclophosphamide with total-body irradiation (TBI) based conditioning regimen and lower body mass index (BMI) were associated with lower CsA-1, while use of fludarabine and higher BMI were associated with higher CsA-1. On multivariate analysis, only fludarabine use and BMI affected CsA-1. Incidence of acute and chronic GVHD (aGVHD and cGVHD), transplant-related mortality, relapse incidence, and relapse-free and overall survival (OS) were similar in the three groups. Conclusion: While fludarabine use in conditioning regimen and higher BMI leads to higher CsA-1, transplant outcomes are not affected by CsA-1.

Print this article
  Search Pubmed for
    -  Gupta A
    -  Punatar S
    -  Gawande J
    -  Mathew L
    -  Kannan S
    -  Khattry N
 Citation Manager
 Article Access Statistics
 Reader Comments
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded39    

Recommend this journal