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Background: Tacrolimus is extensively employed in allogeneic hematopoietic cell transplant (alloHCT) for the prevention of graft-versus-host disease (GvHD). Renal and hepatic toxicities have been associated with increased blood concentrations post alloHCT. Due to the narrow therapeutic index of tacrolimus and variability in blood concentrations, drug monitoring is essential. Difficulties of therapeutic monitoring include dosage forms limited to capsules, drug interactions, and changes in organ function.
Methods: All patients were initiated on 0.005 mg/kg (ideal body weight) intravenously every 12 hours on Day -1 through a central venous catheter. Tacrolimus trough levels were drawn twice weekly by peripheral vein (Tuesday and Fridays). Once levels were stable in the therapeutic range (5 to 15 ng/ml—desired target between 5 to 10 ng/ml), doses were converted to the solution formulation of 1 mg/ml (Elefante et al BBMT 2006). Data were collected from January 2013 to March 2014.
Results: Eighty-seven patients were admitted for alloHCT during this time period. Of these 87 patients, 527 tacrolimus adjustments were performed. These adjustments resulted in 12 out of greater than 10,000 levels drawn to be outside the upper recommended range of 15 ng/ml.
Conclusions: Tacrolimus adjustments utilizing the intravenous and solution dosage forms allowed doses to be adjusted in smaller increments minimizing the frequency of toxic trough levels.