tacrolimus and beta-Thalassemia

Calcineurin inhibitor-induced pain syndrome is an entity recognized in patients on immunosuppressive therapy after transplantation. Diagnosis is characterized by onset of pain beginning in the setting of an elevated calcineurin-inhibitor trough level. Reducing the medication dose relieves symptoms. Imaging findings can be nonspecific, including bone marrow edema and periosteal reaction. We present the unique case of calcineurin inhibitor-induced pain syndrome in a child and review the imaging findings.

Topics: Arthralgia; beta-Thalassemia; Bone Marrow Transplantation; Calcineurin Inhibitors; Female; Humans; Immunosuppressive Agents; Infant; Magnetic Resonance Imaging; Syndrome; Tacrolimus

Hematopoietic stem cell transplantation (HSCT) is an effective treatment for hematological disorders. Tacrolimus is widely used after HSCT, but it has highly interindividual variable pharmacokinetics. Population pharmacokinetics (PPK) researches of tacrolimus in children with β-thalassemia major (β-TM) undergoing HSCT are insufficient.. To establish a PPK model of tacrolimus in children with β-TM and optimize initial dosing regimen for achieving target concentration of 5 to 15 ng/mL.. Data on patients aged <18 years were retrospectively collected from January 2017 to December 2018. PPK analysis and Monte Carlo simulations were performed using nonlinear mixed-effects modeling.. A data set of 55 patients with 332 concentrations was included. A 2-compartment model could best describe the pharmacokinetics of tacrolimus. The body surface area and gender were significant covariates in the final model. The typical value of clearance, the distribution volume of the central room, the distribution volume of the peripheral room, and the intercompartmental clearance were 5.05L/h, 4.33L, 155L, and 6.22L/h, respectively. The optimal initial dosing regimen of 0.03, 0.04, 0.05, 0.06, and 0.10 mg/kg were appropriate for female children with a weight (WT) of 50 to 10 kg. The regimen of 0.04, 0.05, 0.06, 0.07, and 0.12 mg/kg is suitable for male children with a WT of 50 to 10 kg. The probability of target attainment (PTA) of each regimen reached 91%.. A stable PPK model of tacrolimus was established. The proposed dosage regimen reached a good PTA, which could provide a reference for tacrolimus therapy.

Topics: Adolescent; beta-Thalassemia; Child; Child, Preschool; Drug Dosage Calculations; Female; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppressive Agents; Male; Models, Biological; Monte Carlo Method; Retrospective Studies; Tacrolimus

Topics: Acute Disease; Anemia, Sickle Cell; Antisickling Agents; beta-Thalassemia; Bradycardia; Budd-Chiari Syndrome; Cardiopulmonary Resuscitation; Cholestasis, Intrahepatic; Glucocorticoids; Graft Rejection; Heart Arrest; Humans; Hydroxyurea; Immunosuppressive Agents; Liver Failure, Acute; Liver Transplantation; Male; Postoperative Complications; Prednisone; Tacrolimus; Young Adult

Topics: Administration, Topical; beta-Thalassemia; Bone Marrow Transplantation; Chemotherapy, Adjuvant; Child; Chronic Disease; Combined Modality Therapy; Dermatitis, Seborrheic; Dermatologic Agents; Follow-Up Studies; Graft vs Host Disease; Humans; Male; Radiotherapy, Adjuvant; Severity of Illness Index; Tacrolimus; Treatment Outcome