Effectiveness of therapeutic drug monitoring in patients undergoing allogeneic hematopoietic stem cell transplantation

Authors

  • Joice Zuckermann Hospital de Clínicas de Porto Alegre – Porto Alegre (RS), Brazil. https://orcid.org/0000-0001-8247-2703
  • Bruno Mateus de Castro Hospital de Clínicas de Porto Alegre – Porto Alegre (RS), Brazil. https://orcid.org/0000-0002-7013-2127
  • Renata Garcia Ruschel Universidade Federal do Rio Grande do Sul – Departamento de Fisioterapia – Porto Alegre (RS), Brazil. https://orcid.org/0000-0001-7356-119X
  • Lucas Bastos Beltrami Universidade Federal do Rio Grande do Sul – Faculdade de Medicina – Porto Alegre (RS), Brazil. https://orcid.org/0000-0001-5088-5124
  • Rafaela Pivato da Fonseca Universidade Federal do Rio Grande do Sul – Faculdade de Medicina – Porto Alegre (RS), Brazil. https://orcid.org/0009-0008-0613-3994
  • Priscila de Oliveira da Silva Hospital de Clínicas de Porto Alegre – Porto Alegre (RS), Brazil|Universidade Federal do Rio Grande do Sul – Programa de Pós-Graduação em Enfermagem – Porto Alegre (RS), Brazil. https://orcid.org/0000-0002-3767-6800
  • Fernanda Fetter Scherer Hospital de Clínicas de Porto Alegre – Serviço de Hematologia e Transplante de Células-Tronco Hematopoéticas – Porto Alegre (RS), Brazil. https://orcid.org/0000-0002-4118-8199
  • Liane Esteves Daudt Hospital de Clínicas de Porto Alegre – Serviço de Hematologia e Transplante de Células-Tronco Hematopoéticas – Porto Alegre (RS), Brazil|Universidade Federal do Rio Grande do Sul – Programa de Pós-Graduação em Saúde da Criança e do Adolescente – Porto Alegre (RS), Brazil. https://orcid.org/0000-0001-9495-6932
  • Alessandra Aparecida Paz Hospital de Clínicas de Porto Alegre – Serviço de Hematologia e Transplante de Células-Tronco Hematopoéticas – Porto Alegre (RS), Brazil.
  • Bibiana Verlindo de Araújo Universidade Federal do Rio Grande do Sul – Programa de Pós-Graduação em Farmacologia e Terapêutica – Porto Alegre (RS), Brazil. https://orcid.org/0000-0002-9706-0389
  • Leila Beltrami Moreira Universidade Federal do Rio Grande do Sul – Programa de Pós-Graduação em Farmacologia e Terapêutica – Porto Alegre (RS), Brazil. https://orcid.org/0000-0002-4730-7988

DOI:

https://doi.org/10.46765/2675-374X.2025v7n1e349

Keywords:

Hematopoietic stem cell transplantation, HSCT, Effectiveness, Therapeutic drug monitoring, Clinical pharmacist

Abstract

Background: Therapeutic drug monitoring (TDM) aims to prevent excessive immunosuppression, graft rejection, and the emergence of graft-versus-host disease (GVHD) and to control drug interactions. Estimates suggest that acute GVHD (aGVHD) occurs in 30-50% of patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and chronic GVHD (cGVHD) in 50 to 70%. Objective: To evaluate the effectiveness of TDM conducted by a clinical pharmacist on the quality of care for patients undergoing allogeneic HSCT to prevent GVHD and to improve clinical outcomes in comparison with historical controls. Methods: A cohort study of patients who underwent allogeneic HSCT was carried out from January 2015 to December 2017 (control group) and from January 2018 to December 2021 (TDM group). Patients were followed up for 2 years after HSCT. The exposed group received pharmaceutical TDM, considering the clinical pharmacokinetics of cyclosporine, tacrolimus, and busulfan, which was compared to a historical control group without TDM. Results: The control and TDM groups included 85 and 79 patients, respectively. Male patients predominated in this sample, the ages of whom ranged from 0 to 64 years. The incidence of GVHD in the overall cohort totaled 73.8% (n = 164). The incidence of aGVHD and cGVHD showed no significant difference between groups. Survival lasted for three more months (p = 0.04), and mortality was lower (risk ratio 0.55; p = 0.05) in the TDM group. Conclusion: TDM was associated with improved survival and reduced mortality, without significantly affecting the incidence of aGVHD or cGVHD.

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Published

07/03/2026

How to Cite

Zuckermann, J., Castro, B. M. de, Ruschel, R. G., Beltrami, L. B., Fonseca, R. P. da, Silva, P. de O. da, … Moreira, L. B. (2026). Effectiveness of therapeutic drug monitoring in patients undergoing allogeneic hematopoietic stem cell transplantation. JOURNAL OF BONE MARROW TRANSPLANTATION AND CELLULAR THERAPY, 7(1). https://doi.org/10.46765/2675-374X.2025v7n1e349

Issue

Vol. 7 No. 1 (2026): Journal of Bone Marrow Transplantation and Cellular Therapy

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Original article

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Copyright (c) 2026 Joice Zuckermann, Bruno Mateus de Castro, Renata Garcia Ruschel, Lucas Bastos Beltrami, Rafaela Pivato da Fonseca, Priscila de Oliveira da Silva, Fernanda Fetter Scherer, Liane Esteves Daudt, Alessandra Aparecida Paz, Bibiana Verlindo de Araújo, Leila Beltrami Moreira

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