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• W2000303692 abstract "Busulfan (BU) is utilized frequently for myeloablation in children undergoing hematopoietic stem cell transplantation (HSCT). A 7-10% incidence of seizures has been reported for patients receiving BU without any anti-convulsant prophylaxis. The PK profile of Levetiracetam is favorable as an anti-convulsant in this setting. This study compared levetiracetam and fosphenytoin during BU, examining the effect on busulfan levels, efficiency of administration (cost, nursing time, drug compatibility), and efficacy. We performed a retrospective case control study of fosphenytoin (n=20) vs. levetiracetam (n=27) use for seizure prophylaxis during BU conditioning regimens. Patients were matched by age, gender, diagnosis, and type of HSCT. All patients received BU at an initial dose of 0.8 mg/kg to 1 mg/kg, subsequently adjusted to an AUC of 800-1350 μmol/L based on first dose PK. Levetiracetam was given at 10 mg/kg/dose (maximum: 500 mg/dose) intravenously (IV) over 15 minutes every 12 hours. Initial doses were administered 6 to 12 hours prior to first dose of BU and continued at least 24 hours after the completion of BU. Fosphenytoin was administered as a loading dose (15 mg PE/kg) 12-24 hours before BU followed by age appropriate maintenance dosing with intermittent loading doses for subtherapeutic levels. Fosphenytoin was given as IV infusion (duration dependent on dose). Median age for both groups was 8 years, with similar ranges. Both groups contained 15% autologous and 85% allogeneic HSCT. Two seizures occurred in the case control vs. none in the levetiracetam group. BU dose adjustments were required in 20/27 (74%) patients receiving levetiracetam and in 15/20 (75%) fosphenytoin patients to attain AUC goal. Levetiracetam was a shorter infusion, with no drug compatibility issues, level monitoring, or dose adjustments when compared to fosphenytoin. Cost analysis is pending. There is no previous report of using levetiracetam as a single agent for seizure prophylaxis during a BU conditioning regimen in pediatric HSCT patients. When compared to fosphenytoin, in this small number of patients, there were no seizures. Levetiracetam did not alter the frequency of BU dose adjustments and is more efficient to administer. Further, prospective trials using levetiracetam as a single agent to prevent BU induced seizures are needed." @default.
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• W2000303692 date "2010-02-01" @default.
• W2000303692 modified "2023-10-16" @default.
• W2000303692 title "Case Control Study Of Levetiracetam Vs. Fosphenytoin For Seizure Prophylaxis In Children Receiving Busulfan (BU) For Hematopoietic Stem Cell Transplantation (HSCT)" @default.
• W2000303692 doi "https://doi.org/10.1016/j.bbmt.2009.12.135" @default.
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