Conditioning Regimens Intravenous Busulfan for Allogeneic Hematopoietic Stem Cell Transplantation in Infants: Clinical and Pharmacokinetic Results
Bone Marrow Transplantation (2003) 32, 647–651 & 2003 Nature Publishing Group All rights reserved 0268-3369/03 $25.00 www.nature.com/bmt Conditioning Regimens Intravenous busulfan for allogeneic hematopoietic stem cell transplantation in infants: clinical and pharmacokinetic results JH Dalle1, D Wall2, Y Theoret1, M Duval1, L Shaw3, D. Larocque1, C Taylor2, J Gardiner3, MF Vachon1 and MA Champagne1 1Service d’He´matologie et Oncologie Pe´diatrique, Hoˆpital Sainte Justine, Montre´al QC, Canada; 2Methodist Children’s Hospital of South Texas, San Antonio, TX,USA; and 3Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA Summary: tion, very wide inter- and intrapatient systemic exposure is observed with two- to sixfold of coefficient variability. High-dose busulfan is an important component of This wide bioavailability range may be linked to erratic myeloablative regimens. Variable drug exposure may intestinal absorption (7 emesis), variable hepatic metabo- occur following oral administration. Therefore, the use lism, circadianrhythm, geneticpolymorphism of a-glu- of intravenous busulfan has been advocated. Previous tathione-S-transferase, initial diagnosis, previous work has suggested a cumulative dosage of 16 mg/kg for treatment, drug–drug interaction and/or patient age. haematopoietic transplantation in children less than 3 Hepatic and renal clearance mechanisms are generally years of age, but only limited data are available in infants. underdeveloped and inefficient in the neonate, but they Pharmacokinetics of intravanous busulfan administered at may change dramatically in the months following birth. the suggested dosage were studied in 14 infants (median Thus, pharmacokinetically guided dosage adjustment age 4.7 months). Busulfan plasma concentrations were appears mandatory, particularly in children.5,7–12 measured by either GC-MS or HPLC-UV.
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