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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
India
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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.


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    -  Gupta A
    -  Punatar S
    -  Gawande J
    -  Mathew L
    -  Kannan S
    -  Khattry N
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