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급성 이식편대숙주병 예방을 위한 Tacrolimus 적정 혈중농도 설정

Optimal Level of Tacrolimus to Prevent Acute Graft-Versus-Host Disease

병원약사회지 2020년 37권 4호 p.444 ~ 458
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Abstract


Background : Graft versus host disease (GVHD) is a major adverse effect of allogeneic stem cell transplantation and acute graft versus host disease (aGVHD) occurs in 40~50% of recipients. The incidence of aGVHD is higher with unrelated transplantation of incompatible human leukocyte antigen (HLA) and tacrolimus has been shown to be an effective immunosuppressant to prevent from aGVHD. Although there are studies to compare the incidence of GVHD with target blood concentration of tacrolimus, it is hard to conclude the optimal concentration of tacrolimus because of the difference in the study population and practice settings. The aim of this study is to evaluate the optimal concentration of tacrolimus to prevent aGVHD by analyzing the related factors of aGVHD incidence and side effects of tacrolimus.

Methods : This study was retrospectively conducted on Korean adult patients who received tacrolimus after hematopoietic stem cell transplantation from July 2014 to June 2015. This study analyzed the concentration of tacrolimus according to the incidence of aGVHD and its related factors, and side effects of tacrolimus in each range of concentrations.

Results : Among the 115 patients aGVHD occurred in 90 (78.3%) patients and the mean concentration of tacrolimus within 100 days post transplantation was 8.14 ng/ml in aGVHD group and 9.66 ng/ml in non aGVHD group (p=0.015). Mean concentration at 3 week post transplantation was 8.87 ng/ml in grade II-IV aGVHD and 10.09 ng/ml in grade 0-I aGVHD (p=0.048). The incidence of aGVHD was significantly lower with the mean concentration of tacrolimus within 100 days of post transplantation of ≥12 ng/ml group than others. In the analysis of side effect of tacrolimus, hyperkalemia was higher in ≥12 ng/ml group than <8 ng/ml group (p=0.02).

Conclusion : In our study, the mean concentration of tacrolimus of 12 ng/ml within 100 days after transplantation tends to lower the incidence of aGVHD.

키워드

Acute graft-versus-host disease (aGVHD); Stem cell transplantation (SCT); Tacrolimus

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