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Low cyclosporine concentrations in children and time to acute graft versus host disease

Eun Kyung Chung1,2, Jeong Yee3, Jae Youn Kim2

  • 1Graduate School of Converging Clinical & Public Health, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Korea.

BMC Pediatrics
|May 13, 2020
PubMed

Insights

Low cyclosporine (CsA) levels early after allogeneic hematopoietic stem cell transplantation (HSCT) significantly increase the risk of acute graft-versus-host disease (aGVHD) in children. Monitoring CsA concentrations is crucial for preventing aGVHD.

Area of Science:

  • Hematology
  • Immunology
  • Pharmacology

Background:

  • Early achievement of target cyclosporine (CsA) blood concentrations post-transplantation is vital for reducing acute graft-versus-host disease (aGVHD) incidence.
  • Limited research exists on predicting aGVHD risk based on low CsA levels at various time points.

Purpose of the Study:

  • To investigate the association between low CsA concentrations at specific lag days and the occurrence of aGVHD in pediatric patients undergoing allogeneic HSCT.
  • To identify critical time windows for monitoring CsA levels to mitigate aGVHD risk.

Main Methods:

  • Retrospective evaluation of 61 pediatric patients who received allogeneic HSCT and CsA prophylaxis.
  • Analysis of mean CsA concentrations at lag days 0-6, 7-13, and 14-20 preceding aGVHD occurrence.
  • Examination of the correlation between low CsA levels and aGVHD incidence within the first month post-transplantation.

Main Results:

  • Patients with mean CsA concentrations below target at lag days 0-6 showed an 11.0-fold increased incidence of aGVHD.
  • Low CsA concentrations at lag days 7-13 and 14-20 were associated with significantly higher adjusted odds ratios (AORs) for developing aGVHD (108.2 and 12.1, respectively).

Conclusions:

  • Detecting low CsA concentrations necessitates vigilant monitoring and proactive interventions to prevent aGVHD.
  • Timely CsA level monitoring is a critical component of aGVHD prophylaxis in pediatric HSCT recipients.
Abstract

Keywords:
Acute graft versus host diseaseAllogenic hematopoietic stem cell transplantationChildrenCyclosporine

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