Summary:
Bone marrow and peripheral blood stem cell transplantations, despite their curative potential, still carry significant
risks for patients. Toxicity of high-dose chemotherapy is one of the leading causes of peritransplant mortality.
Busulfan is a frequently used chemotherapeutic agent in conditioning regimens prior to transplantations. The choice
of the optimal busulfan dose and prediction of its clinical effect may be very difficult. Absorption of busulfan from
gastrointestinal tract and its metabolism can vary considerably. Several studies published recently showed that the
busulfan plasma concentrations correlate better with the clinical effect and extramedullary toxicity caused by this
drug than with the actual dose administered to the patient. Approximate target plasma concentrations of busulfan,
which meet the optimal balance between the clinical effect and the risk of severe side effects of chemotherapy, were
proposed. Almost twenty chromatographic methods were published, which make the quantitative measurement of
busulfan possible. The maintanance of certain busulfan plasma concentration during its whole administration with
the help of the repeated adjustments of its dosage can reduce the toxicity caused by this agent and improve the results
of bone marrow or peripheral blood stem cell transplantations. This method is easily applicable, has low financal
and personal demands, and technical appliances, which it requires are usually accessible in most transplant center
laboratories.
Key words:
busulfan, pharmacokinetics, dose modifications, area under the curve, chromatography, bone marrow
transplantation.
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