Population pharmacokinetics of intravenous Erwinia asparaginase in pediatric acute lymphoblastic leukemia patients.
| Autor: | Sassen SD; Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands., Mathôt RA; Department of Hospital Pharmacy, Academic Medical Center, University of Amsterdam, the Netherlands., Pieters R; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands., Kloos RQ; Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands., de Haas V; Dutch Childhood Oncology Group, The Hague, the Netherlands., Kaspers GJ; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.; Department of Pediatric Oncology, VU University Medical Center, Amsterdam, the Netherlands., van den Bos C; Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands., Tissing WJ; Department of Pediatric Oncology, Beatrix Children's Hospital, University Medical Center, Groningen, the Netherlands., Te Loo M; Department of Pediatric Hemato-Oncology, Radboud University Nijmegen Medical Center, the Netherlands., Bierings MB; Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht/Wilhelmina Children's Hospital, the Netherlands., Kollen WJ; Department of Pediatric Immunology, Hemato-Oncology and Stem Cell Transplantation, Leiden University Medical Center, the Netherlands., Zwaan CM; Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands., van der Sluis IM; Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands i.vandersluis@erasmusmc.nl. |
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| Jazyk: | angličtina |
| Zdroj: | Haematologica [Haematologica] 2017 Mar; Vol. 102 (3), pp. 552-561. Date of Electronic Publication: 2016 Nov 10. |
| DOI: | 10.3324/haematol.2016.149195 |
| Abstrakt: | Erwinia asparaginase is an important component in the treatment of pediatric acute lymphoblastic leukemia. A large variability in serum concentrations has been observed after intravenous Erwinia asparaginase. Currently, Dutch Childhood Oncology Group protocols dose alterations are based on trough concentrations to ensure adequate asparaginase activity (≥100 IU/L). The aim of this study was to describe the population pharmacokinetics of intravenous Erwinia asparaginase to quantify and gather insight into inter-individual and inter-occasion variability. The starting dose was evaluated on the basis of the derived population pharmacokinetic parameters. In a multicenter prospective observational study, a total of 714 blood samples were collected from 51 children (age 1-17 years) with acute lymphoblastic leukemia. The starting dose was 20,000 IU/m 2 three times a week and adjusted according to trough levels from week three onwards. A population pharmacokinetic model was developed using NONMEM ® A 2-compartment linear model with allometric scaling best described the data. Inter-individual and inter-occasion variability of clearance were 33% and 13%, respectively. Clearance in the first month of treatment was 14% higher ( P <0.01). Monte Carlo simulations with our pharmacokinetic model demonstrated that patients with a low weight might require higher doses to achieve similar concentrations compared to patients with high weight. The current starting dose of 20,000 IU/m 2 might result in inadequate concentrations, especially for smaller, lower weight patients, hence dose adjustments based on individual clearance are recommended. The protocols were approved by the institutional review boards. (Registered at NTR 3379 Dutch Trial Register; www.trialregister.nl). (Copyright© Ferrata Storti Foundation.) |
| Databáze: | MEDLINE |
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