Lower vancomycin trough levels in adults undergoing unrelated cord blood transplantation

Abstract

Vancomycin (VCM) is frequently used for neutropenic patients undergoing cord blood transplantation (CBT). We retrospectively examined the relationship between VCM trough levels and the efficacy and toxicity in 122 adult patients undergoing CBT in our institute. The median initial dose of VCM based on body weight was 9.1 mg/kg/dose (range, 6.0–22.6 mg/kg/dose). The median initial trough level of VCM for all patients was 4.50 µg/mL (range, 1.20–24.05 µg/mL), at a median of 3 days (range, 2–6 days) after VCM administration. The cumulative incidence of acute kidney injury (AKI) was 19% at 30 days after VCM administration. A higher median trough level of VCM during the first 7 days was significantly associated with the development of AKI in the multivariate analysis (Hazard ratio: 1.28, p = .026). These data suggest that a lower VCM trough level may be safe in adult patients undergoing CBT under therapy with nephrotoxic drugs.

Keywords:

• Vancomycin
• trough levels
• cord blood transplantation
• febrile neutropenia
• acute kidney injury
• augmented renal clearance

Acknowledgments

The authors thank all of the physicians and staff at the hospital and the cord blood bank in Japan for their help in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).