Background: Therapeutic drug monitoring for busulfan is important to
prevent adverse events and improve outcomes in stem cell
transplantation. We investigated intravenous busulfan pharmacokinetics
and evaluated the utility of limited sampling strategy (LSS) as a simple
method to estimate the area under the concentration-time curve (AUC).
Procedure: The study comprised 87 busulfan measurements in 54 children
who received intravenous busulfan between August 2015 and May 2020. AUCs
were calculated from 3–5 blood sampling points in each patient, and the
correlation between AUC and plasma concentrations (ng/mL) at 1, 2, 3, 4,
and 6 h after initiating busulfan infusion (C,
C, C, C, and
C, respectively). Results: By one-point sampling
strategy, the most accurate predicted AUC was based on
C (r = 0.789; precision,
11.0%) in all patients. The predicted AUC based on C
was highly precise (r = 0.937; precision,
5.9%) in adolescent patients weighing > 23 kg, but the
correlation was poor in infants and young children weighing ≤23 kg
(r = 0.782; precision, 11.4%). By two-point
sampling strategy, the predicted AUC based on C and
C showed the most favorable performance
(r = 0.943; precision, 6.4%), even in infants
and young children, whereas the predicted AUC based on
C and C was acceptable
(r = 0.963; precision, 5.7%). Conclusions:
The AUC of busulfan can be predicted based on C in
adolescent patients. However, there was substantial inter-individual
variation in busulfan pharmacokinetics in infants and young children, in
whom two-point LSS was necessary for accurate AUC prediction.