ArticleAnnals of behavioral medicine : a publication of the Society of Behavioral Medicine2025
Oral medication adherence predicts cyclosporine blood level variability and graft versus host disease following pediatric allogeneic hematopoietic stem cell transplant.
Article in Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMedication adherence is vital for optimal outcomes following pediatric allogeneic hematopoietic cell transplant (HCT), but current assessment methods have limitations. Cyclosporine (CSA), an immunosuppressive drug used post-HCT, is routinely monitored in post-transplant care. Variability in CSA blood levels has been linked to adherence in other pediatric populations, and the medication level variability index (MLVI) has shown strong associations with adherence behaviors. However, its utility in assessing CSA adherence post-HCT has not been explored. This study aimed to evaluate CSA blood level variability as an objective measure of adherence and establish MLVI as a predictor of disease-related outcomes in pediatric HCT recipients. PURPOSE: To investigate the utility of CSA blood level variability as a measure of medication adherence and the MLVI as a predictor of graft versus host disease (GVHD) in pediatric HCT recipients.
methodMedical and adherence data were collected from 127 children within 90 days post-discharge. Regression analyses assessed relationships between oral CSA adherence, CSA MLVI, and the incidence and grade of acute and chronic GVHD.
resultsGreater oral CSA adherence significantly predicted increased incidence (Est. = .008, P = .001) and severity of chronic GVHD (Est. = .006, P = .023), as well as greater severity of acute GVHD (Est. = .006, P = .002). Adherence did not predict acute GVHD incidence. Higher adherence variability was associated with increased MLVI (Est. = .225, P < .001) and greater severity of both acute (Est. = .004, P = .004) and chronic GVHD (Est. = .014, P < .001), but not their incidence. Greater MLVI significantly predicted increased incidence and severity of both acute (incidence: Est. = .005, P = .001; severity: Est. = .004, P = .002) and chronic GVHD (incidence: Est. = .004, P < .001; severity: Est. = .007, P < .001).
conclusionsInconsistent CSA adherence significantly predicted higher CSA MLVI, which was linked to increased GVHD incidence and severity. These findings highlight the potential of MLVI as a reliable adherence measure and the importance of ongoing adherence support in pediatric HCT care.
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