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Willcox A, Wong E, Nath C, Janson B, Harrison SJ, Hoyt R, Bajel A, Shaw P, Ritchie D, Grigg A. The pharmacokinetics and pharmacodynamics of busulfan when combined with melphalan as conditioning in adult autologous stem cell transplant recipients. Ann Hematol 2018; 97:2509-2518. [DOI: 10.1007/s00277-018-3447-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 07/17/2018] [Indexed: 11/25/2022]
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Barta SK, Jain R, Mazumder A, Carter J, Almanzar L, Browne R, Shahnaz S, Elkind R, Kaminetzky D, Battini R, Derman O, Kornblum N, Verma A, Braunschweig I. Pharmacokinetics-directed Intravenous Busulfan Combined With High-dose Melphalan and Bortezomib as a Conditioning Regimen for Patients With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:650-657. [PMID: 28684379 DOI: 10.1016/j.clml.2017.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/24/2017] [Accepted: 06/08/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has a well-established role in the treatment of patients with multiple myeloma. Melphalan 200 mg/m2 (Mel200) is the most commonly used preparative regimen. Several studies have provided evidence for potential synergism and safety when combining bortezomib (Btz) or busulfan (Bu) with melphalan (Mel). PATIENTS AND METHODS We conducted a prospective phase II study to investigate the safety and efficacy of conditioning with pharmacokinetics (PK)-directed intravenous (IV) Bu with Btz and Mel. Bu dosing was adjusted to target a total area under the curve (AUC) of 20,000 μM × min. Patients received Btz (1 mg/m2 × 4 doses) and Mel (140 mg/m2). RESULTS A total of 19 subjects were enrolled. Their median age was 55 years, and the median follow-up period was 23.7 months. PK testing resulted in 86% of patients achieving an estimated total AUC of 20,000 ± 2500 μM × min. The overall response rate (ORR) at day +100 after ASCT was 100% in the evaluable patients, with 11% of patients achieving a complete response. The 2-year progression-free survival rate was 57.9% (95% confidence interval [CI], 38%-89%), and the 2-year overall survival rate was 88.5% (95% CI, 76%-100%). The most common grade 3 and 4 toxicities were febrile neutropenia, dysphagia/odynophagia, and oral mucositis. No case of hepatic sinusoidal obstruction syndrome developed. One treatment-related mortality occurred before day +100. CONCLUSION A preparative regimen of PK-directed IV Bu with Btz and Mel led to an ORR of 100% with acceptable toxicity and should be considered for direct comparison with the Mel200 regimen in future trials.
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Affiliation(s)
- Stefan K Barta
- Fox Chase Cancer Center, Philadelphia, PA; Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY.
| | - Rishi Jain
- Fox Chase Cancer Center, Philadelphia, PA; Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | - Amithaba Mazumder
- NYU Clinical Cancer Institute, New York, NY; Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Jason Carter
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY; Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Roy Browne
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | | | - Richard Elkind
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | | | | | - Olga Derman
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | - Noah Kornblum
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | - Amit Verma
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
| | - Ira Braunschweig
- Montefiore Medical Center, Albert Einstein Cancer Center, Bronx, NY
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Sakellari I, Mallouri D, Batsis I, Apostolou C, Konstantinou V, Abela EM, Douka V, Marvaki A, Karypidis K, Iskas M, Baliakas P, Kaloyannidis P, Yannaki E, Sotiropoulos D, Kouvatseas G, Smias C, Anagnostopoulos A. Carmustine, etoposide, cytarabine and melphalan versus a newly designed intravenous busulfan-based Busulfex, etoposide and melphalan conditioning regimen for autologous hematopoietic cell transplant: a retrospective matched-pair analysis in advanced Hodgkin and non-Hodgkin lymphomas. Leuk Lymphoma 2015; 56:3071-81. [DOI: 10.3109/10428194.2015.1028054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wang Y, Kato K, Le Gallo C, Armstrong E, Rock E, Wang X. Dosing algorithm revisit for busulfan following IV infusion. Cancer Chemother Pharmacol 2015; 75:505-12. [PMID: 25561350 DOI: 10.1007/s00280-014-2660-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/22/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE Busulfan (Bu) exposure is critical for efficacy and safety. Body weight (BW), or adjusted ideal body weight (AIBW)-based dosing (WBD) algorithm, has been used in hematopoietic stem cell transplantation (HSCT). A recently completed phase 2 study revealed that 33.6 % of the subjects were under-, or over-exposed, with this WBD algorithm. This paper was to investigate Bu dosing algorithm in an attempt to improve the suboptimal Bu exposure. METHODS Population PK modeling was conducted using the data from 207 patients. Dosing algorithm was developed based on derived covariate model of CL. Model-based simulation was conducted to assist test PK study design. A simplified CL estimation method was proposed based on the PK structure model for Bu. RESULTS A one-compartment structure model adequately described the PK profile of Bu following an IV infusion. BSA best described the inter-individual variability of CL. The proposed dosing algorithm was dose (mg) = (31.7 × BSA - 11.6) × target AUC [µM min]/1,000. With this dosing algorithm, 14.3 % patients could be under- or over-exposed. A test PK study with reduced study duration and three PK samples can provide as nearly as good an estimate of CL compared to 12 PK samples on two different occasions. CONCLUSION The proposed dosing algorithm can significantly improve the sub-exposure of Bu. A shortened test PK study duration with reduced PK samples can provide as near as good estimate for Bu CL. A simplified CL estimation method is valid.
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Affiliation(s)
- Yanlin Wang
- Otsuka Pharmaceutical Development and Commercialization, Inc., 506 Carnegie Center Drive, Princeton, NJ, 08540, USA
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Freytes CO, Toro JJ, Yeh RF, Stadtmauer EA, Ratanatharathorn V, Akpek G, Sahovic E, Tricot GJ, Shaughnessy PJ, White DJ, Rodriguez TE, Solomon SR, Yu LH, Zhao C, Patil S, Armstrong E, Smith A, Elekes A, Kato K, Reece DE. Safety and Efficacy of Targeted-Dose Busulfan and Bortezomib as a Conditioning Regimen for Patients with Relapsed Multiple Myeloma Undergoing a Second Autologous Blood Progenitor Cell Transplantation. Biol Blood Marrow Transplant 2014; 20:1949-57. [DOI: 10.1016/j.bbmt.2014.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/07/2014] [Indexed: 12/12/2022]
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