Busulfan Precision Dosing Evolves From TDM Toward Model-Informed Dosing
This narrative review consolidates pediatric busulfan pharmacokinetics, exposure targets, and the practical transition from conventional therapeutic drug monitoring to model-informed precision dosing for transplant pharmacists.
📅 Journal publication: Sep 15, 2026·Last updated: Oct 7, 2026
Optimizing busulfan dosing in pediatric transplants involves bridging TDM with precision models.
Busulfan is crucial in pediatric hematopoietic stem cell transplantation (HSCT) but faces challenges in dosing due to variability and a narrow therapeutic index. Body size is a primary factor affecting busulfan clearance in children. Newer methods like Bayesian estimation and model-informed precision dosing (MIPD) aim to optimize dosing. Current therapeutic drug monitoring (TDM) methods remain essential but incorporating model-based approaches is promising for individualized dosing strategies, pending further validation. Precision dosing of busulfan in pediatric HSCT must balance TDM with emerging model-based techniques for improved accuracy.
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Authors:Zhang XY, Li Y, Xu J, Fang YJ, Ding XS, Chen F
Citation:Zhang XY, Li Y, Xu J, et al. From Therapeutic Drug Monitoring to Model-Informed Precision Dosing: A Review of Busulfan Dosing Optimization in Pediatric Hematopoietic Stem Cell Transplantation. Pharmaceutics. 2026;18(9). doi:10.3390/pharmaceutics18091154
Subscribers receive access to a complete clinical analysis, available online and as a downloadable PDF.
Executive Summary
Study Design
Patient Population
Primary Outcomes
Secondary Outcomes & Safety Profile
Pharmacist Implications
Clinical Pearls
Limitations
Controversies & Evidence Gaps
Cost & Logistics
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