Hematopoietic cell transplantation requires unique calcineurin inhibitor monitoring distinct from solid organ transplant paradigmsImproving Drug Monitoring for Patients Receiving Hematopoietic Cell Transplants

This narrative review evaluates the current pharmacological frameworks for monitoring calcineurin inhibitors, specifically cyclosporine and tacrolimus, in patients undergoing allogeneic hematopoietic cell transplantation. The authors argue that current monitoring practices are scientifically unsound because they are extrapolated from solid organ transplant paradigms. These existing models do not account for the specific physiological challenges of hematopoietic transplantation, such as toxic conditioning, hematologic changes, and systemic inflammation.

The review highlights a significant gap in precision medicine for this patient population. The authors advocate for the development of hematopoietic transplant-specific precision immunosuppression strategies rather than relying on targets derived from solid organ transplant models.

A primary limitation noted is that current monitoring frameworks are not specific to the unique environment of hematopoietic cell transplantation. The review does not provide clinical trial data or specific outcome metrics, as it is a narrative critique of current pharmacological frameworks. Clinical application of these findings is currently limited to the conceptual shift toward specialized monitoring protocols.