Pharmacokinetics and Customized Dosing of Vancomycin in Adult Patients With Hematological Malignancies: Status, Challenges, and Opportunities

Vancomycin (VAN) remains the first-line treatment for methicillin-resistant, multidrug-resistant gram-positive bacterial infections, even among cancer patients. Patients with hematological malignancies (HMs) represent a unique population, whose physiological and pathological changes often differ from those of the general population. These variations may cause significant alterations in the in vivo pharmacokinetics (PK) of VAN, causing unpredictable changes in the safety, efficacy, and bacterial resistance. Customized dosing of VAN (CD_van) offers potential solutions to these challenges. However, there is currently a lack of guideline-based, consensus-driven references, and limited research on the implementation of CD_van in HM patients, particularly in adults. This review concentrates on adult HM patients and reviews studies on VAN PK in them (including population PK and its models), focusing on current mainstream and novel CD_van technologies, including therapeutic drug monitoring-guided, model-guided, closed-loop control systems, and artificial intelligence-guided CD_van technologies. The challenges faced in the broader implementation of these technologies and the promising solutions exploited, such as blockchain technology-driven clinical decision support systems, are also discussed. Understanding the multifaceted aspects of PK research and personalized dosing of VAN in HM patients will help facilitate the rational treatment of VAN, in-depth PK research, and the development of CD_van techniques in HM patients.