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Rossi M, Szepetowski S, Yakouben K, Paillard C, Sirvent A, Castelle M, Pegon C, Piguet C, Grain A, Angoso M, Robin M, Dhedin N, Pondarré C, Dumesnil de Maricourt C, Berceanu A, Simon P, Marcais A, Poirée M, Gandemer V, Plantaz D, Nguyen S, Michel G, Loundou A, Dalle JH, Thuret I. Recent results of hematopoietic stem cell transplantation for thalassemia with busulfan-based conditioning regimen in France: improved thalassemia free survival despite frequent mixed chimerism. A retrospective study from the Francophone Society of Stem Cell Transplantation and Cellular Therapy (SFGM-TC). Bone Marrow Transplant 2023; 58:1254-1256. [PMID: 37542188 DOI: 10.1038/s41409-023-02079-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023]
Affiliation(s)
- Marica Rossi
- Department of Pediatric Hematology, Robert Debré Hospital, GHU APHP Nord, Université Paris Cité, Paris, France.
| | - Sarah Szepetowski
- Department of Pediatric Hematology and Oncology, Rare Disease Center for Thalassemia, La Timone Hospital, Marseille, France
| | - Karima Yakouben
- Department of Pediatric Hematology, Robert Debré Hospital, GHU APHP Nord, Université Paris Cité, Paris, France
| | - Catherine Paillard
- Department of Pediatric Hematology and Oncology, Hautepierre Hospital, Strasbourg, France
| | - Anne Sirvent
- Department of Pediatric Hematology and Oncology, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Martin Castelle
- Department of Pediatric Immunology and Hematology, Necker-Enfants Malades Hospital, Paris, France
| | - Charline Pegon
- Department of Pediatric Hematology and Oncology, Estaing Hospital, Clermont-Ferrand, France
| | - Christophe Piguet
- Department of Pediatric Hematology and Oncology, Mother and Child University Hospital, Limoges, France
| | - Audrey Grain
- Department of Pediatric Hematology and Oncology, University Hospital of Nantes, Nantes, France
| | - Marie Angoso
- Department of Pediatric Hematology and Oncology, Pellegrin Hospital, Bordeaux, France
| | - Marie Robin
- Department of Stem Cell Transplantation, Saint-Louis Hospital, GHU APHP Nord, Université Paris Cité, Paris, France
| | - Nathalie Dhedin
- Unit of Hematology for Adolescents, Saint-Louis Hospital, Paris, France
| | - Corinne Pondarré
- Rare Disease Center for Sickle Cell Disease, Centre Hospitalier Intercommunal de Créteil, Créteil, INSERM U955, Paris Est Créteil University, Créteil, France
| | | | - Ana Berceanu
- Department of Adult Hematology, Jean Minjoz Hospital, Besançon, France
| | - Pauline Simon
- Department of Pediatric Hematology and Oncology, Jean Minjoz Hospital, Besançon, France
| | - Ambroise Marcais
- Department of Adult Hematology, Necker-Enfants Malades Hospital, Paris, France
| | - Maryline Poirée
- Department of Pediatric Hematology and Oncology, University Hospital of Nice, Nice, France
| | - Virginie Gandemer
- Department of Pediatric Hematology and Oncology, University Hospital of Rennes, Rennes, France
| | - Dominique Plantaz
- Department of Pediatric Hematology and Oncology, University Hospital of Grenoble, Grenoble, France
| | - Stéphanie Nguyen
- Department of Hematology, La Pitié-Salpêtrière Hospital, Paris, France
- Francophone Society of Stem Cell Transplantation and Cellular Therapy (SFGM-TC), Paris, France
| | - Gérard Michel
- Department of Pediatric Hematology and Oncology, Rare Disease Center for Thalassemia, La Timone Hospital, Marseille, France
| | - Anderson Loundou
- Unit for Clinical and Epidemiological Research, DRRC/AP-HM Faculté de Médecine de Marseille, Marseille, France
| | - Jean-Hugues Dalle
- Department of Pediatric Hematology, Robert Debré Hospital, GHU APHP Nord, Université Paris Cité, Paris, France
| | - Isabelle Thuret
- Department of Pediatric Hematology and Oncology, Rare Disease Center for Thalassemia, La Timone Hospital, Marseille, France
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Beyron C, Ceraulo A, Bertrand Y, Bleyzac N, Philippe M. Impact of a Bayesian Individualization of Cyclosporine Dosage Regimen for Children Undergoing Allogeneic Hematopoietic Cell Transplantation: A Cost-Effectiveness Analysis. Ther Drug Monit 2021; 43:481-489. [PMID: 33814541 DOI: 10.1097/ftd.0000000000000886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/19/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cyclosporine A (CsA) is the main drug used to prevent graft-versus-host disease in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). CsA therapeutic drug monitoring (TDM) has been performed for ages, with studies revealing clinical benefits, but failing to examine its economic impact. In this article, the main objective was to evaluate the economic impact of the CsA TDM strategy, based on a Bayesian approach, by assessing costs related to its clinical impact. Furthermore, TDM effectiveness was analyzed for pharmacokinetics and clinical outcomes. METHODS A cost-effective, nonrandomized, retrospective, single-center study compared 2 CsA monitoring and dose adaptation strategies in pediatric patients undergoing HSCT. From 2014 to 2016, CsA TDM was performed using a population pharmacokinetics model-coupled Bayesian approach by a pharmacist ["pharmacist-assisted individualization" (PAI)]. From 2017 to 2018, CsA TDM was performed by the clinician without a Bayesian approach (non-PAI group). HSCT costs were evaluated from the French National Insurance perspective. Economic and clinical outcomes were assessed by measuring incremental cost-effectiveness ratios. RESULTS The study included 144 patients: 90 and 54 patients in PAI and non-PAI groups, respectively. Both groups were comparable for sociodemographic and clinical characteristics. The mean total cost per patient was significantly lower (P < 0.01) in the PAI group (€85,947) than in the non-PAI group (€100,435). Multivariate analysis revealed that TDM based on the Bayesian approach was a protective factor (odds ratio = 0.86) for severe acute graft-versus-host disease. We noted that pharmacist-based TDM was the dominant strategy. Bayesian method-based TDM allowed an increase in the percentage of target attainment at any period post-HSCT. CONCLUSIONS CsA TDM with a Bayesian approach is a cost-effective procedure, and highlighted clinical benefits encourage the development of new TDM strategies for HSCT.
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Affiliation(s)
- C Beyron
- Oncology Pharmacy Department, Centre Léon Bérard
| | - A Ceraulo
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon
- Claude Bernard University-Lyon 1
| | - Y Bertrand
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon
- Claude Bernard University-Lyon 1
| | - N Bleyzac
- Pharmacy Department, Hôpital Pierre Garraud, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon; and
- EMR 3738, Team 2-PK/PD Modeling in Oncology, Lyon-Sud Faculty of Medicine, Oullins, France
| | - M Philippe
- Oncology Pharmacy Department, Centre Léon Bérard
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon
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Kuijvenhoven MA, Wilhelm AJ, Meijer E, Janssen JJWM, Swart EL. TRough versus AUC Monitoring of cyclosporine: A randomized comparison of adverse drug reactions in adult allogeneic stem cell recipients (TRAM study). Eur J Haematol 2021; 107:364-369. [PMID: 34114691 DOI: 10.1111/ejh.13674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the incidence and severity of adverse drug reactions of cyclosporine using AUC-targeted therapeutic drug monitoring (TDM) compared to trough level (Ctrough )-targeted TDM in adult allogeneic stem cell recipients. METHODS Blind, monocenter, intervention study. Subjects were 1:1 randomized into either an AUC group or a Ctrough group. Adverse drug reactions were accessed two and four weeks after start of treatment. RESULTS Forty patients were included, resulting in 15 evaluable subjects (AUC group) and 13 evaluable subjects (Ctrough group). Grade two/three toxicity was observed in 46% (Ctrough group) versus 60% of subjects (AUC group) (P = .463). There was no significant difference between two and four weeks after start of cyclosporine for nausea (P = .142 resp. P = .122), renal dysfunction (P = .464 resp. P = 1.000), and hypomagnesemia (P = 1.000 resp. P = .411). Subjects in the AUC group reached the therapeutic goal earlier (72,7% versus 43,0% at third sampling point, P = .332) and were within the target range more consistently. CONCLUSION This study showed no reduction in incidence and severity of cyclosporine-induced toxicity with AUC- versus trough level-targeted TDM. Although modeled dosing based on AUC led to faster optimal target attainment, this did not result in less toxicity in the early days after transplantation.
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Affiliation(s)
- Marianne A Kuijvenhoven
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Abraham J Wilhelm
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ellen Meijer
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jeroen J W M Janssen
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Eleonora L Swart
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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