Clinical and laboratory characteristics of patients with voriconazole-induced skeletal disease
| . | Patient 1 . | Patient 2 . | Patient 3 . |
|---|---|---|---|
| Diagnosis | AML | AML | ALL |
| Age at diagnosis, y | 46 | 37 | 55 |
| Sex | Female | Female | Female |
| Body mass index, kg/m2 | 17.5 | 24.4 | 19.4 |
| Allogeneic stem cell transplantation | |||
| Conditioning | Cy/TBI | Cy/TBI | Cy/TBI |
| Donor | MSD | MSD | MSD |
| GVHD prophylaxis | CsA/MTX | CsA/MTX | CsA/MTX |
| Voriconazole treatment days until onset of skeletal disease | 100 | 177 | 226 |
| Total voriconazole dose until onset of skeletal disease, g | 55 | 97.4 | 133.6 |
| Median voriconazole level (IQR)*/no. of measurements | 1.6 (0.85)/12 | 1.95 (0.9)/14 | 1.2 (1.35)/15 |
| Laboratory values during voriconazole treatment/3 wks after voriconazole cessation | |||
| Glomerular filtration rate, mL/min† | 57/65 | 31/50 | 32/46 |
| ALP, U/L‡ | 195/102 | 384/214 | 202/125 |
| ALT, U/L§ | 106/92 | 38/30 | 9/13 |
| Fluoride level, μg/L‖ | NA | 363/70 | 316/136 |
| CsA level, μg/L | 154/NA | 106/50 | 226/179 |
| . | Patient 1 . | Patient 2 . | Patient 3 . |
|---|---|---|---|
| Diagnosis | AML | AML | ALL |
| Age at diagnosis, y | 46 | 37 | 55 |
| Sex | Female | Female | Female |
| Body mass index, kg/m2 | 17.5 | 24.4 | 19.4 |
| Allogeneic stem cell transplantation | |||
| Conditioning | Cy/TBI | Cy/TBI | Cy/TBI |
| Donor | MSD | MSD | MSD |
| GVHD prophylaxis | CsA/MTX | CsA/MTX | CsA/MTX |
| Voriconazole treatment days until onset of skeletal disease | 100 | 177 | 226 |
| Total voriconazole dose until onset of skeletal disease, g | 55 | 97.4 | 133.6 |
| Median voriconazole level (IQR)*/no. of measurements | 1.6 (0.85)/12 | 1.95 (0.9)/14 | 1.2 (1.35)/15 |
| Laboratory values during voriconazole treatment/3 wks after voriconazole cessation | |||
| Glomerular filtration rate, mL/min† | 57/65 | 31/50 | 32/46 |
| ALP, U/L‡ | 195/102 | 384/214 | 202/125 |
| ALT, U/L§ | 106/92 | 38/30 | 9/13 |
| Fluoride level, μg/L‖ | NA | 363/70 | 316/136 |
| CsA level, μg/L | 154/NA | 106/50 | 226/179 |
AML indicates acute myeloid leukemia; ALL, acute lymphoblastic leukemia; Cy/TBI, cyclophosphamide/total body irradiation (12 Gy); MSD, HLA-matched sibling donor; CsA/MTX, cyclosporine/methotrexate; ALP, alkaline phosphatase; ALT, alanine aminotransferase; and NA, not applicable.
Target serum levels for voriconazole 1.0-6.0 mg/L, posaconazole > 1.0 mg/L, and itraconazole > 1.0 mg/L.
According to the CKD-EPI formula.
Normal: 35-104 U/L.
Normal: 10-35 U/L.
Normal: < 30 μg/L.