Pharmacokinetics of high-dose busulphan in relation to age and chronopharmacology

Summary

Busulphan levels in plasma were measured in 27 patients during conditioning therapy (1 mg/kg×4 for 4 days) before bone marrow transplantation. The mean minimal concentration found in children aged <5 years (237 ng ml⁻¹) was lower than that observed in adults or older children (607 and 573 ng ml⁻¹, respectively). The AUC for the last dose was significantly lower in young children (2,315 h ng ml⁻¹) than in adults or older children (6,134 and 5,937 h ng ml⁻¹, respectively). The elimination half-life for the last dose in young children was shorter (2.05 h) than that in either adults (2.59 h) or older children (2.79 h). When the AUC was normalized for body surface area, the difference between young children and the other groups was smaller but remained statistically significant. The total body clearance was significantly higher in young children (7.3 ml min⁻¹ kg⁻¹) as compared with both older children and adults (3.02 and 2.7 ml min⁻¹ kg⁻¹, respectively). The plasma levels of busulphan showed circadian rhythmicity, especially in young children. The concentration measured during the night in some patients was up to 3-fold that observed during daytime. We conclude that the busulphan dosage for children must be reconsidered and that further studies are urgently needed to develop an optimal therapy.