{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T00:51:28Z","timestamp":1762044688233,"version":"build-2065373602"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01 CA157460-01"],"award-info":[{"award-number":["R01 CA157460-01"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Medication 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Medical and adherence data were collected from 127 children within 90\u2009days post-discharge. Regression analyses assessed relationships between oral CSA adherence, CSA MLVI, and the incidence and grade of acute and chronic GVHD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Greater 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 &amp;lt; .001) and greater severity of both acute (Est. = .004, P = .004) and chronic GVHD (Est. = .014, P &amp;lt; .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 &amp;lt; .001; severity: Est. = .007, P &amp;lt; .001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Inconsistent 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/abm\/kaaf055","type":"journal-article","created":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T07:45:12Z","timestamp":1749282312000},"source":"Crossref","is-referenced-by-count":0,"title":["Oral medication adherence predicts cyclosporine blood level variability and graft versus host disease following pediatric allogeneic hematopoietic stem cell transplant"],"prefix":"10.1093","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4433-5924","authenticated-orcid":false,"given":"Kimberly L","family":"Klages","sequence":"first","affiliation":[{"name":"Behavioral Medicine and Clinical Psychology, Cincinnati Children\u2019s Hospital Medical Center , 3333 Burnet Ave , Cincinnati, OH 45229,","place":["United States"]},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine , 3230 Eden Ave , Cincinnati, OH 45267,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie L","family":"Chardon","sequence":"additional","affiliation":[{"name":"Behavioral Medicine and Clinical Psychology, Cincinnati Children\u2019s Hospital Medical Center , 3333 Burnet Ave , Cincinnati, OH 45229,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7034-9553","authenticated-orcid":false,"given":"Lisa A","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Division of Oncology, The Children\u2019s Hospital of Philadelphia , 3401 Civic Center Blvd , Philadelphia, PA 19104,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean","family":"Phipps","sequence":"additional","affiliation":[{"name":"Department of Psychology, St Jude Children\u2019s Research Hospital , 262 Danny Thomas Place , Memphis, TN 38105,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah N","family":"Drake","sequence":"additional","affiliation":[{"name":"Center for Biobehavioral Health, Nationwide Children\u2019s Hospital , 700 Children's Dr , Columbus, OH 43205,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micah","family":"Skeens","sequence":"additional","affiliation":[{"name":"Center for Biobehavioral Health, Nationwide Children\u2019s Hospital , 700 Children's Dr , Columbus, OH 43205,","place":["United States"]},{"name":"Department of Pediatrics, The Ohio State University School of Medicine , 1645 Neil Ave , Columbus, OH 43210,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahna L","family":"Pai","sequence":"additional","affiliation":[{"name":"Center for Biobehavioral Health, Nationwide Children\u2019s Hospital , 700 Children's Dr , Columbus, OH 43205,","place":["United States"]},{"name":"Department of Pediatrics, The Ohio State University School of Medicine , 1645 Neil Ave , Columbus, OH 43210,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"2025110120493574500_kaaf055-B1","first-page":"1417","volume-title":"Current Use and Trends in Hematopoietic Cell Transplantation in the United States","author":"D\u2019Souza","year":"2017"},{"key":"2025110120493574500_kaaf055-B2","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.cpem.2011.07.005","article-title":"Emergent complications in the pediatric hematopoietic stem cell transplant patient","volume":"12","author":"Munchel","year":"2011","journal-title":"Clin Pediatr Emerg Med"},{"key":"2025110120493574500_kaaf055-B3","doi-asserted-by":"crossref","first-page":"e13451","DOI":"10.1111\/petr.13451","article-title":"The Medication Level Variability Index 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