Patients undergoing bone marrow transplantation from different donors need to  receive immunosuppressants to prevent the attack of their own cells by the donor cells; the ensuing immunosuppression state predisposes them to fungal infections that mandate addition of antifungal agents on a preventive basis. Cyclosporine and voriconazole are two medications that belong to the two categories respectively. These two medications are known to interact because of the complex process of drug metabolism, drug efflux into the cell. Nowadays, it is well known that “Pharmacogenomics”, the variability of the genetic background of individuals, implies the presence of a different set of enzymes that determine the fate of these two medications. Clinically, it is observed that the pattern of interaction is distinct among different individuals with some individuals sustaining toxicity from cyclosporine when receiving voriconazole concomitantly. This interaction might lead to subtherapeutic dosing of cyclosporine and the need to escalate the prescribed dose to achieve a therapeutic concentration with the possibility of higher risk in terms of decrease in renal function, elevation in blood pressure.. This study aims at understanding the role of pharmacogenomics in the different pattern of interaction among voriconazole and cyclosporine.

 Blood sample will be collected and DNA will be extracted then process in a special kit designed to probe for the different mutations in the genes coding for the enzymes in charge of metabolism of these medications. In parallel, the medical records of the patients will be reviewed and specific parameters related to cyclosporine toxicity will be recorded such as: blood pressure, change in creatinine, prescribed dose, serum trough concentration..