白消安在儿童造血干细胞移植预处理中的研究进展

Research progress of busulfan in conditioning regimen of hematopoietic stem cell transplantation in children

白消安在造血干细胞移植(HSCT)预处理中发挥重要作用,但是其安全血药浓度范围狭窄,存在药物代谢动力学(PK)参数的高变异性,并且易受药物剂型、患者因素、药物间相互作用等多种因素影响。白消安PK参数变异性较高,可影响HSCT后移植物植入情况及相关并发症发生。由于儿童脏器发育不完善及体重不断变化等因素,白消安用药期间更加需要重视对其进行血药浓度监测。目前,关于儿童HSCT预处理方案中,白消安个体化用药及剂量调整的相关研究仍较少。笔者通过白消安PK参数的影响因素、白消安血药浓度与HSCT后移植物植入情况及相关并发症的关系,以及PK参数指导下的白消安剂量调整等,对白消安在儿童HSCT预处理中的研究进展进行综述,旨在为儿童HSCT预处理中白消安的临床应用提供参考。

Busulfan plays an important role in conditioning of hematopoietic stem cell transplantation(HSCT),but with narrow safe blood drug level and high variability of pharmacokinetics(PK)parameters.Blood drug level of busulfan is affected by many factors,such as drug dosage forms,patients′self-characteristics,drug interactions and so on.Due to the high variability of PK parameters of busulfan,it can affect graft implantation and related complications after HSCT.In addition,due to the factors such as incomplete development of organs and constant change of body weight in children,it is necessary to pay more attention to monitoring of busulfan blood drug level during medication.At present,there are still few studies on the individualized medication and dose adjustment of busulfan in conditioning regimen of children′s HSCT.This article summarizes research progresses of busulfan in conditioning regimen of HSCT in children through the factors affecting the PK parameters of busulfan,the relationship among the blood concentration of busulfan,graft implantation and related complications after HSCT,as well as the dosage adjustment under the guidance of PK parameters of busulfan,in order to provide a reference for clinical application of busulfan in conditioning regimen of children HSCT.