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To explore the effect of cyclosporin blood drug concentration on the efficacy and safety of cyclosporin on patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the transplant bin.
Clinical medical records of 94 allo-HSCT patients were collected. The first day of stem cell infusion was +1 day (d), and the transplantation time was divided into four groups: group A (-9 d to -1 d), group B (+1 d to +7 d,) group C (+8 d to +14 d) and group D (+15 d to +21 d). The plasma concentration of cyclosporin and its influencing factors,cell implantation, liver and kidney function indexes, acute graft-versus-host disease (aGVHD), and the occurrence of cyclosporin-related adverse reactions were observed in different periods and their relationships with the plasma concentration of cyclosporin were analysed. Receiver operating characteristic (ROC) curve was used to analyze the value of serum concentration of cyclosporin at different time periods in predicting safety.
The concentration of cyclosporin in allo-HSCT patients was 128 (99,160) ng·mL-1, with statistically significant differences between different time periods (P<0.001). In allo-HSCT patients, the implantation rate of leukocyte, platelet, and neutrophil in +21 d was 94%, 64%, and 51%, respectively. The incidence of liver injury, kidney injury, and aGVHD was 47% (44/94), 71% (67/94), and 16% (15/94), respectively. ROC analysis showed that the warning value of cyclosporin blood concentration in the group A for liver injury and kidney injury was 128.5 ng·mL-1 and 113.5 ng·mL-1, respectively, while the area under the curve was 0.712 (95%CI：0.578 to 0.847，P=0.002) and 0.752 (95%CI：0.637 to 0.868，P<0.001), respectively.
There are many factors affecting the blood concentration of cyclosporin which can affect the clinical efficacy and safety. Timely and accurate monitoring of cyclosporin blood concentration can better guide the clinical treatment of allo-HSCT patients in the transplant bin.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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