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Monitoring cyclosporine using blood drawn via a central venous catheter

Bone Marrow Transplantation volume 32, page 1037 (2003)Cite this article

Cyclosporin A (CsA) is given to allogeneic haematopoietic stem cell transplant (HSCT) recipients to prevent acute graft-versus-host-disease. The drug is usually administered intravenously for the first 2–3 weeks because of the gastrointestinal toxicity induced by myeloablative conditioning, and its concentration should be monitored to ensure adequate and safe levels. Blood is still obtained by venepuncture (VP) in some centres including ours, even though these patients all have a central venous catheter (CVC) in place to allow ready venous access, because there have been reports of falsely high CsA levels attributed to the reversible fixation of CsA to the catheter wall.1,2,3 We started using triple lumen CVCs in 1999 and were interested to see whether or not CsA levels measured in blood obtained via the CVC were as reliable as those found in blood obtained by VP. We chose a cohort of 10 consecutive adult recipients of an HLA-A, -B, DRB and DQB partially (98%) T-cell-depleted sibling bone marrow because they were participating in a pharmacokinetic study of itraconazole. Each patient was managed with a polyurethane, noncuffed triple-lumen catheter (20 cm, seven French; Arrow International, Inc., Reading, PA, USA) inserted into the subclavian vein. Cyclosporine was given at a dose of 3 mg/kg/day intravenously by continuous infusion exclusively through the distal lumen. We obtained paired blood samples as follows: blood was drawn by VP on HSCT days 0, +7, +14, +21 and +28 (if still in the hospital) for immediate assay, and a further 10 ml sample was obtained via the proximal lumen of the CVC after discarding the first 10 ml of blood and stored at −30°C for later determination. The concentration of cyclosporine was measured using a monoclonal whole-blood fluorescence polarisation immunoassay (FLx; Abbott Laboratories, North Chicago, IL, USA) capable of detecting 25–1500 μg/l drug with coefficient variation of less than 4%.

These results clearly support our contention that blood drawn through a multiple-lumen CVC can be used reliably to monitor CsA levels with three important caveats. (1) The catheter material should not be silicone as this has a higher capacity for binding CsA4 than polyurethane or a similar hydrophobic material. (2) The lumen used for obtaining blood samples should not be used to infuse CsA5 and should preferably be located at the downstream end of the catheter.6 (3) The first 10 ml of blood drawn through the lumen should be discarded. Should levels exceed 1500 μg/l, as occurred twice in our series, consideration should be given to obtaining a second sample of blood by VP.

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  1. Department of Haematology, University Medical Centre Nijmegen, Nijmegen, 6500, HB, The Netherlands

    J P Donnelly, N M A Blijlevens & A V M B Schattenberg

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  1. J P Donnelly
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  2. N M A Blijlevens
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  3. A V M B Schattenberg
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Donnelly, J., Blijlevens, N. & Schattenberg, A. Monitoring cyclosporine using blood drawn via a central venous catheter. Bone Marrow Transplant 32, 1037 (2003). https://doi.org/10.1038/sj.bmt.1704273

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