Pharmacocinétique du mofétilmycophénolate en greffe hématopoïétique : étude d’un cas pédiatrique
Bibliographic record
Abstract
Resume Objectif : Connaitre les particularites de la pharmacocinetique du mycophenolate mofetil en greffe hematopoietique a l’aide d’un cas clinique. Resume du cas : Patiente de onze ans ayant recu du mycophenolate mofetil comme immunosuppresseur a la suite de deux greffes hematopoietiques en raison d’une neurotoxicite a la cyclosporine et d’une insuffisance renale au tacrolimus. De nombreux dosages de creux seriques ont ete effectues chez cette patiente, mais une seule aire sous la courbe a ete calculee. Il a ete tres difficile d’obtenir des niveaux therapeutiques de mofetilmycophenolate malgre les doses tres elevees qui lui ont ete administrees. La patiente a developpe une maladie du greffon contre l’hote digestive, cutanee et hepatique chronique. Discussion : La pharmacocinetique du mofetilmycophenolate est bien connue en greffe renale. En greffe hematopoietique, son utilisation est beaucoup plus recente et sa pharmacocinetique peu connue. A la lumiere des donnees actuelles, il semble que son temps de demi-vie serait plus court, qu’il n’y aurait pas de recirculation enterohepatique et que sa biosdisponibilite varierait beaucoup chez les patients ayant subi une greffe hematopoietique par rapport aux patients ayant eu une greffe renale. Conclusion : La pharmacocinetique du mycophenolate mofetil en greffe renale ne peut etre extrapolee a la pharmacocinetique en greffe hematopoietique. Beau - coup de questions demeurent quant aux valeurs visees, au meilleur analysat, au moment opportun pour doser le produit ainsi qu’a la relation entre l’efficacite et les effets indesirables. Abstract Objective: With the help of a clinical case, to learn the specifics of the pharmacokinetics of mycophenolate mofetil in hematopoietic transplants. Case Summary: Following two hematopoietic transplants, an 11-year old patient received mycophenolate mofetil for immunosuppression after having experienced neurotoxicity with cyclosporine and renal failure with tacrolimus. Numerous serum trough levels were done in this patient, but only one area under the curve was calculated. Despite high administered doses, it was very difficult to obtain therapeutic levels of mycophenolate mofetil. The patient developed gastrointestinal and cutaneous graft versus host disease as well as chronic hepatitis. Discussion: The pharmacokinetics of mycophenolate mofetil are well studied in renal transplant. In hematopoietic transplant, however, its use is more recent and little is known about its pharmacokinetics. In light of actual data, it seems to have a shorter half-life and no enterohepatic recirculation. Its bioavailability also seems to vary considerably in hematopoietic transplant patients as opposed to in renal transplant patients. Conclusion: The pharmacokinetics of mycophenolate mofetil in renal transplant cannot be extrapolated to hematopoietic transplant. Many questions remain about target values, the best analyzer, the opportune time to measure levels, and the relationship between efficacy and side effects. Key Words: mycophenolate mofetil; mofetilmycophenolate;mycophenolic acid; pharmacokinetics; hematopoietic transplant; bone marrow transplant; pediatrics .
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".