Factors associated with optimized tacrolimus dosing in hematopoietic stem cell transplantation

Allison R. Butts, Victoria T. Brown, Lauren D. McBride, Javier Bolaños-Meade, Amy W. Bryk

Research output: Contribution to journalArticlepeer-review

Abstract

Objective The primary objective was to analyze the initial tacrolimus concentrations achieved in allogeneic hematopoietic stem cell transplantation patients using the institutional dosing strategy of 1 mg IV daily initiated on day +5. The secondary objectives were to ascertain the tacrolimus dose, days of therapy, and dose changes necessary to achieve a therapeutic concentration, and to identify patient-specific factors that influence therapeutic dose. The relationships between the number of pre-therapeutic days and incidence of graft-versus-host disease and graft failure were delineated. Methods A retrospective chart review included adult allogeneic hematopoietic stem cell patients who received tacrolimus for graft-versus-host disease prophylaxis in 2012. Descriptive statistics, linear and logistic regression, and graphical analyses were utilized. Results Ninety-nine patients met the inclusion criteria. The first concentration was subtherapeutic (<10 ng/ml) in 97 patients (98%). The median number of days of tacrolimus needed to achieve a therapeutic trough was 10 with a median of two dose changes. The median therapeutic dose was 1.6 mg IV daily. Approximately 75% of patients became therapeutic on ≤ 2 mg IV tacrolimus daily. No relationship was found between therapeutic dose and any patient-specific factor tested, including weight. No relationship was found between the number of days of therapy required to achieve a therapeutic trough and incidence of graft-versus-host disease or graft failure. Conclusion An initial flat tacrolimus dose of 1 mg IV daily is a suboptimal approach to achieve therapeutic levels at this institution. A dose of 1.6 mg or 2 mg IV daily is a reasonable alternative to the current institutional practice.

Original languageEnglish (US)
Pages (from-to)275-283
Number of pages9
JournalJournal of Oncology Pharmacy Practice
Volume22
Issue number2
DOIs
StatePublished - Apr 1 2016

Keywords

  • Tacrolimus
  • allogeneic stem cell transplantation
  • graft failure
  • graft-versus-host disease
  • immunosuppression

ASJC Scopus subject areas

  • Oncology
  • Pharmacology (medical)

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