Despite the availability of effective antiviral drugs, human cytomegalovirus (CMV) infection is still a serious life-threatening complication in recipients of allogeneic hematopoietic stem cell transplantation. Ganciclovir (GCV) preemptive therapy is currently the usual treatment for CMV disease and antigenemia. However, prolonged GCV therapy results in the emergence of drug-resistant virus. Most GCV-resistant clinical CMV isolates contain a mutation in the UL97 phosphotransferase gene. We report a case that GCV-resistant CMV antigenemia by UL97 phosphotransferase mutant strain at codon 460 and 605 which was improved by reduction of immunosuppressants for posttransplant lymphoproliferative disease after unrelated cord blood transplantation.
Antiviral Agents ; Codon ; Cytomegalovirus ; Fetal Blood* ; Ganciclovir ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunosuppressive Agents

Immune thrombocytopenia (ITP) is caused by platelet autoantibodies and T-cell dysregulation. Both platelets and their precursor megakaryocytes may be targeted leading to platelet destruction and insufficient production. Current treatments for ITP, including corticosteroids, rituximab, splenectomy and TPO receptor agonists can not reverse the disease process and can be limited by their side effects including infection and thrombosis. New methods, such as anti-CD154 antibody, FcγRIIb and Syk (spleen tyrosine kinase) inhibitor, can target at certain key steps in the disease process, showing the potential to limite systemic side effects and to decrease the morbidity and mortality of ITP patients. In this article, the recent therapeutic strategies, the new types of drugs and the further study orientation (or the way of further studies) are reviewed.
Autoantibodies ; Blood Platelets ; Humans ; Immunosuppressive Agents ; Megakaryocytes ; Purpura, Thrombocytopenic, Idiopathic ; T-Lymphocytes

Female ; Humans ; Immunosuppressive Agents ; therapeutic use ; Middle Aged ; Sjogren's Syndrome ; blood ; drug therapy ; alpha-Fetoproteins ; analysis

Adolescent ; Adult ; Aged ; Cyclosporine ; blood ; Female ; Genes, MDR ; Genotype ; Humans ; Immunosuppressive Agents ; blood ; Kidney Transplantation ; Male ; Middle Aged ; Polymorphism, Genetic

BACKGROUND: Splenectomy is often performed for the patients with refractory chronic immune thrombocytopenic purpura (ITP). Still, there are no generally accepted guidelines for the minimum level of platelet count and the average requirement of platelet transfusion so that the patients can safely undergo splenectomy. We evaluated the changes of platelet count and transfusion requirements around the splenectomy in patients with chronic ITP. METHODS: We reviewed the medical records of 25 patients with chronic ITP. We compared the platelet counts at admission, immediately pre-op and several post-op days. We also investigated the number of platelet concentrates transfused around splenectomy. We determined the effect of splenectomy according to Difino's classification. RESULTS: The median platelet counts of the patients was 18x109/L (7-238x109/L) on admission and recovered to 108x109/L (22-460x109/L) on preoperation day by platelet transfusion and immunosuppressive treatment. The platelet counts were rapidly recovered after splenectomy from the day of operation. Only 3 patients needed platelet transfusion after splenectomy. Thirteen among twenty five patients (52%) underwent operation without platelet transfusion support. Most transfusions were done before the surgery and 80% (12/15) of the patients required transfusion of more than 10 units of random donor platelet concentrate. Twenty one patients (84%) showed the complete remission after splenectomy. CONCLUSION: Splenectomy can lead to rapid remission even in most cases of refractory chronic ITP. Many cases can undergo the operation only with treatment modalities other than transfusion such as immunosuppressive agents and/or immunoglobulin. The minimum level of platelet counts for splenectomy may be safe over 50x109/L and about 10 units of platelet concentrate may be enough for preparation of splenectomy.
Blood Platelets* ; Classification ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Medical Records ; Platelet Count ; Platelet Transfusion* ; Purpura, Thrombocytopenic, Idiopathic* ; Splenectomy* ; Tissue Donors

Myelodysplastic syndrome is a group of diseases characterized by abnormal clonal proliferation of hematopoietic cells and pancytopenia with dysplasia. The pathogenesis of MDS includes factors of chromosome aberrations, gene mutations, immune abnormalities, environmental changes, and so on. Now it is commonly accepted that MDS is a multistep process disorder involving more etiologic alterations. Recently more and more investigations indicate that the abnormality of cellular immunity is one of important reasons related to MDS. Some proofs about the abnormal activation of T-cell and the abnormal expressions of cytokines in different stages of immune response in MDS have been documented, meanwhile, numerous clinical studies on immune therapy in MDS provide a great number of evidences to disclose its immune abnormalities.
Cytokines ; blood ; Humans ; Immunosuppressive Agents ; therapeutic use ; Lymphocyte Activation ; Myelodysplastic Syndromes ; drug therapy ; immunology ; Signal Transduction ; T-Lymphocytes ; immunology

OBJECTIVETo evaluate the short and long term therapeutic efficacy of the immunosuppressive therapy(IST) for adult severe aplastic anemia(SAA), and to analysis the relationship between the clinical factors(age, typing, lymphocyte percentage, reticulocyte percentage, neutrophil count) and the response to IST.

METHODSThe response rate of 39 patients received the IST between September 2009 and September 2013 in our hospital was assayed, the effective time in which all patients had hematologic response, and the survival rate at the first year were analyzed. The survival rates, the average amounts of the RBC and Plt transfusion per month in the first year were compared by using χ2 test between the IST group and the non-IST group; the multinomial logistic regression was used to analyze the relationship between the clinical factors and the response to IST.

RESULTSThe response rates of the 39 SAA patients at the first month, the third month, the sixth month and the first year were 29.73%, 70.27%, 75.68%, 86.49%, respectively. The median effective time of hematologic response in all patients had was 61.5 d(10 d-344 d). The survival rate of the IST group was 92.31%, which was much higher than that of the non-IST group (P<0.05). The average amounts of the RBC and Plt transfusion per month at the first year in the IST group were 1.04(0.13-2.78)×400 ml and 1.38(0.17-5.10)×200 ml, respectively, which were much lower than those in the non-IST group (P<0.01). Among the five clinical factors, the age, lymphocyte percentage and neutrophil count related to the response of IST (P<0.05).

CONCLUSIONThe response rate of the 39 SAA patients received IST is 86.49% at the first year, and their long term survival is better than that of non-IST group. The age, lymphocyte percentage and neutrophil count relate to the response of IST.

Adult ; Anemia, Aplastic ; Blood Transfusion ; Cyclosporine ; Humans ; Immunosuppressive Agents ; Leukocyte Count ; Logistic Models ; Neutrophils ; Reticulocytes ; Survival Rate

OBJECTIVETo evaluate safety and efficacy of conversion of calcineurin inhibitors (CNI) to sirolimus (SRL) therapy for treatment of new-onset diabetes after kidney transplantation (NODAT).

METHODSOf 321 kidney transplant recipients, 34 patients who developed NODAT (10.59%) were divided into 3 groups to receive continued CNI therapy at a reduced dose (group A, 14 cases), sirolimus conversion therapy (group B, 12 cases), or oral hypoglycemic drugs (group C, 12 cases). All the patients had dietary and exercise therapies, and insulin injections were given in patients with postprandial (2 h) blood glucose over 14.0 mmol/L. The patients were followed up regularly for 5 years.

RESULTSThe mean blood glucose level was 13.02∓1.74 mol/L upon the diagnosis of NODAT in the 34 patients without significant differences between the 3 groups. At 6 months of therapy, fasting plasma glucose levels in the 3 groups decreased to 8.05 ∓2.45, 7.45∓2.44, and 9.30∓3.89 mmol/L, repsectively; at 12 months, blood glucose became normal in both groups A and B, but the patients in group A needed a greater daily insulin dose (P<0.05). In group B, the mean serum creatinine level was 165.1∓61.82 mmol/L at the conversion and lowered to 150∓53.05 mmol/L at 5 years (P<0.05), which were similar to those in group A at the two time points (152∓43.05 and 145.88∓53.05 mmol/L, respectively; P>0.05). In group C, creatinine level further increased after medication with oral hypoglycemic drugs. At 5 years, the patient and graft survival rates were 100% and 75% in group A, respectively, similar to those in group B (83.4% and 68%, respectively; P>0.05); group C showed lower patient and graft survival rates than groups B and C.

CONCLUSIONConversion from CNI to SLR therapy can significantly the metabolism of patients with NODAT without increasing the risk of acute graft rejection.

Blood Glucose ; Calcineurin Inhibitors ; therapeutic use ; Diabetes Mellitus ; Graft Rejection ; prevention & control ; Humans ; Hypoglycemic Agents ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; Sirolimus ; therapeutic use

This study is to establish an artificial neural network (ANN) for predicting blood tacrolimus concentration in liver transplantation recipients. Tacrolimus concentration samples (176 samples) from 37 Chinese liver transplantation recipients were collected. ANN established after network parameters were optimized by using momentum method combined with genetic algorithm. Furthermore, the performance of ANN was compared with that of multiple linear regression (MLR). When using accumulated dose of 4 days before therapeutic drug monitoring (TDM) of tacrolimus concentration as input factor, mean prediction error and mean absolute prediction error of ANN were 0.02 +/- 2.40 ng x mL(-1) and 1.93 +/- 1.37 ng x mL(-1), respectively. The absolute prediction error of 84.6% of testing data sets was less than 3.0 ng x mL(-1). Accuracy and precision of ANN are superior to those of MLR. The correlation, accuracy and precision of ANN are good enough to predict blood tacrolimus concentration.
Adult ; Aged ; Drug Monitoring ; methods ; Female ; Humans ; Immunosuppressive Agents ; blood ; Linear Models ; Liver Transplantation ; Male ; Middle Aged ; Neural Networks (Computer) ; Tacrolimus ; blood

Due to an extreme shortage of cadaveric kidneys, many centers in Japan successfully performed ABO-incompatible kidney transplantations using plasmapheresis, splenectomy and immunosuppression. Recently, a protocol including anti-CD20 monoclonal antibody (rituximab) and antigen-selective immunoadsorption has been used for ABO-incompatible transplantation in Europe. In Korea, ABO-incompatible kidney transplantation has been rarely performed. We report an experience of successful ABO-incompatible kidney transplantation using plasmapheresis and rituximab. The patient was a 32-yr-old female suffering from chronic renal failure, and her blood type was O, Rh+. The donor was her husband, and his blood type was B, Rh+. A combination therapy including 5 times of plasmapheresis starting from 10 days before transplantation with 2-day interval, intravenous gammaglobulin, rituximab at 2 weeks before transplantation and potent immunosuppression successfully decreased the titers of anti-A and anti-B antibodies to 1:2 and 1:1, respectively. The kidney transplantation was successful without any sign of hyperacute or acute rejection.
*ABO Blood-Group System ; Adult ; Antibodies, Monoclonal/*therapeutic use ; *Blood Group Incompatibility ; Female ; Humans ; Immunosuppressive Agents/therapeutic use ; *Kidney Transplantation ; Plasmapheresis ; Transplantation Conditioning