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Cyclosporin A and bone marrow transplantation

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Cyclosporin

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Summary

The use of cyclosporin A (CsA) in human marrow transplantation was first reported in 19781. Shortly thereafter, its use in minimizing graft-versus-host disease (GVHD) by inducing graft—host tolerance was reported2. It has been shown to be effective in minimizing both the incidence of GVHD and marrow graft rejection. Both these complications of marrow transplantation are mediated by T cells, the former by those in the infused donor marrow and the latter by those of the recipient. CsA has been shown to be as effective as methotrexate, the previously used standard agent, in minimizing the incidence and severity of acute GVHD. The combination of CsA and methotrexate is superior in this regard compared to either drug used alone. CsA is also useful in treating both acute and chronic GVHD once they become established. The incidence of viral infections, including cytomegalovirus pneumonitis, is the same with each drug. CsA is associated with a faster rate of marrow engraftment and less oropharyngeal mucositis than methotrexate. However, it is associated with more nephrotoxicity and hypertension than methotrexate. Hepatotoxicity and neurotoxicity are also seen with its use in this patient population. In some prospective randomized trials, although not in others, the incidence of recurrent leukaemia in patients given CsA appears greater than in those given methotrexate. CsA has also been used as immunosuppression after mismatched family member and matched unrelated donor transplantation, and again it appears that the combination of CsA and methotrexate is useful. CsA interacts with a number of other medications commonly used in marrow transplant recipients, particularly aminoglycoside antibiotics and amphotericin B, sulphadimidine and trimethoprim, melphalan, ketoconazole, Cimetidine, phenytoin, erythromycin, rifampicin and the contraceptive pill. If the use of these agents cannot be avoided, extra care in monitoring the patient’s clinical course is required.

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  1. Kerry Atkinson
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  1. Immunopathology Laboratory, Department of Pathology, University of Aberdeen, Foresterhill, Aberdeen, AB9 2ZD, Scotland

    Angus W. Thomson BSc(Hons), MSc, PhD, DSc, MRCPath, FIBiol (Reader in Immunology) (Reader in Immunology)

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© 1989 Kluwer Academic Publishers

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Atkinson, K. (1989). Cyclosporin A and bone marrow transplantation. In: Thomson, A.W. (eds) Cyclosporin. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-0859-8_7

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  • DOI: https://doi.org/10.1007/978-94-009-0859-8_7

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