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2016 ; 55
(5
): 551-93
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Pharmacokinetics, Pharmacodynamics, and Pharmacogenomics of Immunosuppressants in
Allogeneic Hematopoietic Cell Transplantation: Part II
#MMPMID26620047
McCune JS
; Bemer MJ
; Long-Boyle J
Clin Pharmacokinet
2016[May]; 55
(5
): 551-93
PMID26620047
show ga
Part I of this article included a pertinent review of allogeneic hematopoietic
cell transplantation (alloHCT), the role of postgraft immunosuppression in
alloHCT, and the pharmacokinetics, pharmacodynamics, and pharmacogenomics of the
calcineurin inhibitors and methotrexate. In this article (Part II), we review the
pharmacokinetics, pharmacodynamics, and pharmacogenomics of mycophenolic acid
(MPA), sirolimus, and the antithymocyte globulins (ATG). We then discuss target
concentration intervention (TCI) of these postgraft immunosuppressants in alloHCT
patients, with a focus on current evidence for TCI and on how TCI may improve
clinical management in these patients. Currently, TCI using trough concentrations
is conducted for sirolimus in alloHCT patients. Several studies demonstrate that
MPA plasma exposure is associated with clinical outcomes, with an increasing
number of alloHCT patients needing TCI of MPA. Compared with MPA, there are fewer
pharmacokinetic/dynamic studies of rabbit ATG and horse ATG in alloHCT patients.
Future pharmacokinetic/dynamic research of postgraft immunosuppressants should
include '-omics'-based tools: pharmacogenomics may be used to gain an improved
understanding of the covariates influencing pharmacokinetics as well as
proteomics and metabolomics as novel methods to elucidate pharmacodynamic
responses.