A rapid immunoassay to determine concentrations of busulfan in plasma
7111 Background: High-dose busulfan is an important component of many bone marrow transplantation preparative regimens. High busulfan plasma levels have been shown to increase the chance of veno-occlusive disease and low levels are associated with recurrence of disease or graph rejection. Currently, busulfan levels are monitored by physical methods which are expensive and time- consuming, resulting in relatively low overall use of busulfan testing for dose adjustment. Methods: Novel, highly selective antibodies for busulfan have been generated and micro-titer plate immunoassays that are capable of quantifying busulfan levels in plasma have been developed. The assay was configured using a busulfan-horseradish peroxidase conjugate as the reporter group and busulfan monoclonal antibodies. The assay requires only 5 μL of plasma per determination with no sample preparation. Results: The immunoassay has a standard curve based on busulfan with a range of 75 to 2,000 ng/mL. The time to first result is 30 minutes with up to 240 tests generated per hour. The coefficient of variation (CV) on signal is < 5% for an entire plate and the 95% confidence interval for negative samples (n=78) is below the lowest calibrator of 75 ng/mL. Cross-reactivity with the major inactive metabolites (tetrahydrothiophene,tetramethyl sulfone and tetrahydrothiophene-3-ol-1,1-dioxide), are <0.1%. Clinical samples (n=70) correlate well to LC-MSMS or GC-MS (R > 0.97) with a slope of < 1.05. Conclusions: This immunoassay method may be suitable for determining levels of busulfan in human plasma. It offers the advantages of using a smaller sample size, does not require sample preparation and is less labor intensive than other methods. The ability to make 240 determinations per hour enables effective routine monitoring of busulfan levels in clinical practice. No significant financial relationships to disclose.