Frieder Keller
University Hospital Ulm-University of Ulm, Germany
Title: Fall in leukocyte count for monitoring of immunosuppressive and anti-cancer drug therapy
Biography
Biography: Frieder Keller
Abstract
Background: The therapeutic window between effi cacy on the one side and toxicity on the other side is very narrow for many immunosuppressive, anti-viral and anti-cancer drugs. The present contribution is to review the literature data and our own experience with regard to the value of a leukocyte monitoring for effi cient drug therapy.
Methods: If there is leukocytopenia at least an eff ect can be assumed. Since the benefi cial eff ect and the adverse effect are
frequently better correlated than the drug concentration and the target eff ect, monitoring of leukocytes might be more cost-eff ective than monitoring of drug concentrations. A selective PubMed research was undertaken, therefore, to look for publications where the monitoring of leukocytes is used for targeting the drug dose.
Results: The use of cyclophosphamide has been successfully introduced for treatment of systemic vaxculitis by adjusting the dose to the leukocyte count. A leukocyte nadir was found to indicate a better prognosis in lung cancer and testicular cancer patients. A better outcome has been associated with cancer chemotherapy targeting neutropenia than with lower dose. This is in agreement with our own experience on the intravenous cyclophosphamide pulse therapy in IgA nephritis. This regimen applies also to the monitoring of azathioprine or mycophenolate and to ganciclovir and valganciclovir or cidofovir. However, a
threshold nadir for leukocyte count must be defi ned to avoid persistent agranulocytosis.
Conclusion: Leukocytopenia is an eff ect of immunosuppression, of anti-viral or anti-cancer drug therapy. This easy to measure lab parameter can be used for pharmacodynamic monitoring of the effi cacy of the critical dose drug therapy.
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