Cyclosporine Monitoring

1986 ◽  
Vol 20 (9) ◽  
pp. 649-652 ◽  
Author(s):  
Gilbert J. Burckart ◽  
Daniel M. Canafax ◽  
Gary C. Yee
Keyword(s):  
Bone Marrow ◽  
Drug Response ◽  
Organ Transplant ◽  
Marrow Transplant ◽  
Immunosuppressive Agent ◽  
Solid Organ ◽  
Routine Monitoring ◽  
Transplant Center ◽  
Patient Variables ◽  
Extreme Variability

Cyclosporine is an important immunosuppressive agent in organ and bone marrow transplantation. The pharmacokinetics of cyclosporine are quite complex and are complicated by the availability of two assay systems that yield differing results. This article summarizes the views from two major solid organ transplant centers and one bone marrow transplant center on important cyclosporine monitoring questions. A general consensus exists in the four areas discussed that: (1) cyclosporine concentrations must be monitored due in part to the extreme variability in kinetics, (2) either blood or plasma can be used in monitoring programs, (3) the radioimmunoassay or high pressure liquid chromatography can be used in routine monitoring, and (4) the interpretation of cyclosporine concentrations must be performed in relation to patient variables that affect drug response and toxicity.

Cyclosporine Monitoring

2007 ◽  
Vol 41 (7-8) ◽  
pp. 1277-1280 ◽  
Author(s):  
William J. Taylor ◽  
J. Daniel Robinson ◽  
Gilbert J. Burckart ◽  
Daniel M. Canafax ◽  
Gary C. Yee
Keyword(s):  
Bone Marrow ◽  
Drug Response ◽  
Organ Transplant ◽  
Marrow Transplant ◽  
Immunosuppressive Agent ◽  
Solid Organ ◽  
Routine Monitoring ◽  
Transplant Center ◽  
Patient Variables ◽  
Extreme Variability

Cyclosporine is an important immunosuppressive agent in organ and bone marrow transplantation. The pharmacokinetics of cyclosporine are quite complex and are complicated by the availability of two assay systems that yield differing results. This article summarizes the views from two major solid organ transplant centers and one bone marrow transplant center on important cyclosporine monitoring questions. A general consensus exists in the four areas discussed that: (1) cyclosporine concentrations must be monitored due in part to the extreme variability in kinetics, (2) either blood or plasma can be used in monitoring programs, (3) the radioimmunoassay or high pressure liquid chromatography can be used in routine monitoring, and (4) the interpretation of cyclosporine concentrations must be performed in relation to patient variables that affect drug response and toxicity.

Recombinant humanized anti-IL-2 receptor antibody (daclizumab) produces responses in patients with moderate aplastic anemia

Blood ◽  
2003 ◽  
Vol 102 (10) ◽  
pp. 3584-3586 ◽  
Author(s):  
Jaroslaw P. Maciejewski ◽  
Elaine M. Sloand ◽  
Olga Nunez ◽  
Carol Boss ◽  
Neal S. Young
Keyword(s):  
Monoclonal Antibody ◽  
Bone Marrow ◽  
Aplastic Anemia ◽  
Neutrophil Count ◽  
Bone Marrow Failure ◽  
Interleukin 2 ◽  
Immunosuppressive Agent ◽  
Solid Organ ◽  
Bone Marrow Failure Syndrome ◽  
Humanized Monoclonal Antibody

AbstractIn contrast to severe aplastic anemia (sAA), the appropriate management of patients with moderate pancytopenia is unclear. In this study, we examined the efficacy of a humanized monoclonal antibody recognizing interleukin-2 receptor (daclizumab), which has proven to be a successful immunosuppressive agent in solid organ and bone marrow transplantation. We treated 17 patients with moderate aplastic anemia (mAA) with 1 mg/kg every 2 weeks for 3 months. mAA was defined as depression of 2 of the 3 blood counts: absolute neutrophil count 1200/mm3 or less, platelet count 70 000/mm3 or less, hemoglobin level 8.5 g/dL or lower, and absolute reticulocyte count 60 000/mm3 or less. The primary end point of our protocol was a hematologic response in at least one affected peripheral blood value. Daclizumab had little toxicity. Six of the 16 (38%) evaluable patients responded to treatment. Two patients with previously chronic disease showed complete return of normal counts, which were sustained for more than 2 years following treatment. Four patients had single-lineage responses. Two previously transfusion-dependent patients became transfusion independent; one patient with many neutropenia-related infections had a normal neutrophil count following treatment. Daclizumab appears safe; its efficacy in this pilot protocol suggests that expanded study of this monoclonal antibody in immune-mediated bone marrow failure syndrome is warranted. (Blood. 2003; 102:3584-3586)

scholarly journals Case report: Rare myeloid sarcoma development following renal transplantation with KRAS and DNMT3A gene mutations

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Danyang Wu ◽  
Xiaoxuan Lu ◽  
Xiaojing Yan ◽  
Ran Gao
Keyword(s):  
Bone Marrow ◽  
Renal Transplantation ◽  
Malignant Tumors ◽  
Clinical Manifestations ◽  
Gene Mutations ◽  
Kaposi Sarcoma ◽  
Normal Karyotype ◽  
Marrow Transplant ◽  
Myeloid Sarcoma ◽  
Solid Organ

Abstract Background A high incidence of malignant tumors, such as post-transplant lymphoproliferative disorders (PTLD), Kaposi sarcoma, and renal cancer is common in solid organ and bone marrow transplant recipients. However, myeloid sarcoma (MS) after renal transplantation has rarely been reported and the diagnosis is challenging due to its low incidence. Case presentation Here, we report a rare case of a 49-year-old man who developed myeloid sarcoma (MS) in the transplanted kidney two years after renal transplantation. Next-generation sequencing (NGS) showed mutations of KRAS and DNMT3A genes in the MS, and no gene mutations in the bone marrow. He presented a normal karyotype of 46, XY. Following treatment with 6 cycles of systemic chemotherapy, the patient was in satisfactory condition with stable serum creatinine (sCr) levels at the 1-year follow-up. In addition, we performed a detailed review with emphasis on the clinical manifestations, and the diagnostic and therapeutic processes of another 7 patients who developed MS following renal transplantation. Conclusions Our report illustrates the clinical utility of comprehensive genomic profiling in benefiting the diagnosis of MS, the selection of therapeutic strategy and the determination of whether MS is donor-derived.

Monitoring Human Blood Dendritic Cell Numbers in Normal Individuals and in Stem Cell Transplantation

Blood ◽  
1999 ◽  
Vol 93 (2) ◽  
pp. 728-736 ◽  
Author(s):  
D.B. Fearnley ◽  
L.F. Whyte ◽  
S.A. Carnoutsos ◽  
A.H. Cook ◽  
D.N.J. Hart
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Mononuclear Cells ◽  
Marrow Transplant ◽  
Allogeneic Bone ◽  
Normal Ranges ◽  
Body Tissues ◽  
Routine Monitoring ◽  
Inflammatory Stimuli ◽  
The Mean

Abstract Dendritic cells (DC) originate from a bone marrow (BM) precursor and circulate via the blood to most body tissues where they fulfill a role in antigen surveillance. Little is known about DC numbers in disease, although the reported increase in tissue DC turnover due to inflammatory stimuli suggests that blood DC numbers may be altered in some clinical situations. The lack of a defined method for counting DC has limited patient studies. We therefore developed a method suitable for routine monitoring of blood DC numbers, using the CMRF44 monoclonal antibody (MoAb) and flow cytometry to identify DC. A normal range was determined from samples drawn from 103 healthy adults. The mean percentage of DC present in blood mononuclear cells (MNC) was 0.42%, and the mean absolute DC count was 10 × 106 DC/L blood. The normal ranges for DC (mean ± 1.96 standard deviation [SD]) were 0.15% to 0.70% MNC or 3 to 17 × 106 DC/L blood. This method has applications for monitoring attempts to mobilize DC into the blood to facilitate their collection for immunotherapeutic purposes and for counting blood DC in other patients. In preliminary studies, we have found a statistically significant decrease in the blood DC counts in individuals at the time of blood stem cell harvest and in patients with acute illnesses, including allogeneic bone marrow transplant (BMT) recipients with acute graft-versus-host disease (aGVHD).

scholarly journals Immunocompromised Seroprevalence and Course of Illness of SARS-CoV-2 in One Pediatric Quaternary Care Center

2020 ◽  
Author(s):  
Megan Culler Freeman ◽  
Glenn J Rapsinski ◽  
Megan L Zilla ◽  
Sarah E Wheeler
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Care Center ◽  
Organ Transplant ◽  
Respiratory Illness ◽  
Marrow Transplant ◽  
Solid Organ ◽  
Rt Pcr ◽  
Cross Sectional ◽  
Course Of Illness

Abstract Background The burden of coronavirus disease 2019 (COVID-19) is poorly understood in pediatric patients due to frequent asymptomatic and mild presentations. Additionally, the disease prevalence in pediatric immunocompromised patients remains unknown. Methods This cross-sectional study tested convenience samples from pediatric patients who had clinically indicated lab work collected and an immunocompromising condition, including oncologic diagnoses, solid organ transplant (SOT), bone marrow transplant, primary immunodeficiency, and rheumatologic conditions or inflammatory bowel disease on systemic immunosuppression, for the presence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results We tested sera from 485 children and observed SARS-CoV-2 seroprevalence of 1.0% (Confidence Interval [CI] 95%: 0.3%–2.4%). Two patients were positive by nasopharyngeal (NP) swab Reverse transcriptase polymerase chain reaction (RT-PCR), but only 1 seroconverted. Patients with oncologic diagnoses or SOT were most likely to be tested for COVID-19 when presenting with respiratory illness as compared with other groups. Conclusions Seroprevalence of antibodies to SARS-CoV-2 in immunocompromised children was similar to that of an immunocompetent pediatric population (0.6%, CI 95%: 0.3%–1.1%), suggesting an adequate antibody response. However, none of the patients who tested positive for antibodies or via NP RT-PCR had more than a mild illness course and 2 patients did not have any reported illness, suggesting that SARS-CoV-2 may not cause a worse clinical outcome in immunosuppressed children, in contrast to immunocompromised adults.

Surgical Considerations in Solid-Organ Transplant Recipients

2015 ◽  
Author(s):  
Thomas A. Pham ◽  
Marc L. Melcher
Keyword(s):  
Immunosuppressive Agents ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Surgical Techniques ◽  
Postoperative Management ◽  
Solid Organ ◽  
Medication Regimen ◽  
Transplant Patients ◽  
Transplant Center ◽  
Number Of Patients

Advances in the management and the surgical techniques of solid-organ transplantation have led to a growing number of patients living longer with transplanted organs. Surgical intervention in these patients ideally should be carried out by the original transplant team; however, the goal of this review is to provide information for practicing surgeons who are not at a transplant center so that they may recognize transplant-related problems, to help decide when to perform an intervention or operation and when to consider transfer to a transplant center. With careful attention to medications and symptoms, general surgery principles will hold true with transplant patients. Minor procedures can usually be conducted without much modification, and major procedures may require some adjustment of the medication regimen. This review covers preoperative considerations, diagnostic and radiologic considerations, intraoperative considerations, management of perioperative infection, management of perioperative immunosuppression, postoperative management, when to consider transfer to a transplant center, special considerations, and annotated key references. Tables list anatomic and diagnostic details of abdominal organ transplants, and considerations for common immunosuppressive agents. This review contains 2 tables and 44 references

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