Monitoring mycophenolate mofetil is necessary for the effective prophylaxis of acute GVHD after cord blood transplantation

Population pharmacokinetics and pharmacodynamics of mycophenolic acid using the prospective data in patients undergoing hematopoietic stem cell transplantation

“…The examined model largely depends on the experimental design, and we would like to pick up clinical significant covariates on the PK of MPA in a routine clinical care as shown in the previous our study. 8 Additionally, although our population size was modest, the estimated parameters, such as the ratio of EHC of MPAG or the IC 50 for MPA, were similar to those of previous reports. 14 Therefore, the constructed PK/PD model for MPA was considered to be appropriate.…”

“…5 The pharmacokinetics (PK) of MPA exhibit a large inter-and intra-individual variability, and it is recommended that the area under the concentration-time curve (AUC) of MPA be monitored for individualized therapy in solid organ transplant recipients. 6,7 Recently, Arai et al 8 proposed that MPA drug monitoring was necessary for the effective prophylaxis of acute GvHD undergoing cord blood stem cell transplantation (CBT). However, information regarding the optimal dose of MMF or the target range for MPA concentrations in HCT patients is limited.…”

Pharmacokinetics, Pharmacodynamics, and Pharmacogenomics of Immunosuppressants in Allogeneic Hematopoietic Cell Transplantation: Part II

“…10,77 A total MPA AUC 0–24h less than 40 μg×h/mL) is associated with a higher cumulative incidence of grades II–IV acute GHVD in single UCB graft alloHCT recipients. 78 Monitoring trough concentrations is appealing in terms of patient convenience, but total MPA trough concentrations correlate poorly with AUC 0–τ at steady-state in alloHCT recipients. 10 A weak correlation exists between total and unbound MPA concentrations, 11,19 but quantification of unbound MPA concentrations is not routinely available.…”

“…78,87,104,115,116 In the largest study to date, sirolimus pharmacokinetics/pharmacodynamics were retrospectively analyzed for associations with development of thrombotic microangiopathy (TMA) in 177 adult patients receiving a sirolimus/tacrolimus regimen as postgraft immunosuppression after reduced-intensity or myeloablative conditioning. 116 Patients either received a sibling donor graft (N=82) or a human leukocyte antigen (HLA)-matched unrelated donor graft (N=95).…”

Prophylactic and therapeutic treatment of graft-versus-host disease in Japan

“…They reported a significantly higher engraftment rate (90 vs. 69 %) and a lower incidence of pre-engraftment immune reaction (16 vs. 52 %) in the Tac and MMF group, but the incidences of acute and chronic GVHD were comparable between the two groups. A certain plasma level of MMF may be necessary to effectively prevent acute GVHD after CBT [86].…”