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Year : 2017  |  Volume : 13  |  Issue : 6  |  Page : 981-988

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, Tata Memorial Centre, Mumbai, Maharashtra, India
2 Department of Biostatistics, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Mumbai, Maharashtra, India

Correspondence Address:
Dr. 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
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.157338

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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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