Расчет и коррекция дозы цитостатических препаратов в режимах кондиционирования перед аллоТГСК у пациентов с избытком массы тела или ее дефицитом

Abstract

In Russia, like in the rest of the world, the number of overweight people has been growing for the last 20 years. According to different studies, obesity and overweight incidence among adults is 20.5–54.0 %. Obesity incidence increased from 10.8 % in 1993 to 27.9 % in 2017 in men and from 26.4 to 31,8 % in women, respectively. Pharmacokinetics of drugs including cytostatic agents, differs in obese vs. normal-weight patients. This is accounted for by renal/hepatic clearance changes as well as by increased distribution of lipophilic drugs with their enhanced protein-binding ability. All these factors create a challenge for a correct calculation of drug doses for obese patients. This issue becomes particularly acute when such patients undergo allogeneic hematopoietic stem cell transplantation with preconditioning regimens using sublethal drug doses. This paper attempts to review current approaches to drug dose calculation to be used in preconditioning regimens for over- and underweight patients.