Prophylactic Use of FK506 for Acute Graft-Versus-Host Disease in Unrelated BMT.
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Acute graft-versus-host-disease (GVHD) remains a major problem, limiting the success of bone marrow transplantation (BMT), particularly so in unrelated BMT. We are currently employing FK506 for prophylaxis of acute GVHD in unrelated BMT. The efficacy and toxicity of FK506 are presented. Twelve patients have undergone unrelated BMT. Among them, ten patients received FK506 as prophylaxis for GVHD. For the first 5 patients, FK506 was begun on the day before BMT as a continuous infusion at a dose of 0.1 mg/ kg/day. However three of the 5 patients had to stop FK506 due to the toxicity (renal dysfunction or convulsions). Thereafter, FK506 was started at a initial dose of 0.05 mg/kg/day, and the dose was adjusted to keep the blood level between 20 and 40 ng/ml for the remaining 5 patients. Three of the 5 patients who received CsA (cyclosporine) or discontinued FK506 developed severe acute GVHD (grade III-IV), but two of the 7 patients who completed FK506 prophylaxis developed severe acute GVHD. All patients treated with FK506 revealed nephrotoxicity, and mostly depended on higher blood level of FK506 at the beginning. Other major side effects were hypertension (6 of 10), hyperglycemia (2 of 10) and convulsion (1 of 10). Recovery of neutrophils was quicker when compared with conventional prophylaxis (CsA+ short course methotrexate). Prophylactic use of FK506 seemed to be effective. Although we need a comparative study before any conclusions can be reached, our preliminary results suggest some advantage of FK506 use in the prevention of acute GVHD. It is important, however, to control the side effects of FK506 such as nephrotoxicity, hypertension and hyperglycemia. Therefore, careful monitoring of the blood level of FK506 is critical.
- 特定非営利活動法人 日本小児血液・がん学会の論文
特定非営利活動法人 日本小児血液・がん学会 | 論文
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