Azacitidine therapy for low-risk myelodysplastic syndrome developing after solid organ transplantation
Azacitidine therapy for low-risk myelodysplastic syndrome developing after solid organ transplantation
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阿扎胞苷治疗实体器官移植后发生的低危骨髓增生异常综合征
DOI：
10.11406/rinketsu.58.138
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Matsumura I.
中科院分区：
文献类型：
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作者：
Inoue H;Morita Y;Rai S;Kakutani H;Ohyama Y;Taniguchi Y;Tanaka H;Shimada T;Tatsumi Y;Ashida T;Matsumura I.
实体器官移植后的免疫抑制治疗已知是发生骨髓增生异常综合征（MDS）的危险因素。在此，我们报告了 2 例患者，两人在实体器官移植后均出现低危 MDS，并成功接受阿扎胞苷 (AZA) 治疗。第1例是一名74岁男性，接受了肝移植。最初的免疫抑制治疗包括环孢素和泼尼松龙。移植九年后，他被诊断患有骨髓增生异常综合征（RCMD）。第2例为一名47岁女性，接受尸体肾移植。最初的免疫抑制治疗包括环孢素、硫唑嘌呤和泼尼松龙。移植后二十七年，她患上了骨髓增生异常综合征（RA）。两名患者均接受 75 mg/m2AZA 治疗，每天一次，连续 5 天，一个 28 天的周期。 2个疗程后，两名患者均实现了血液学改善（IWG 2006标准），且没有严重（3/4级）非血液学不良事件。此外，AZA不影响器官移植的移植物植入和功能状态。总之，AZA 对于实体器官移植后的 MDS 患者来说是一种安全有效的药物。然而，需要长期随访来证实AZA对于接受实体器官移植的患者的安全性和有效性。
Immunosuppressive therapy after solid organ transplantation is known to be a risk factor for the development of myelodysplastic syndromes (MDS). Herein, we report 2 patients, both of whom developed low-risk MDS after solid organ transplantation and were successfully treated with azacitidine (AZA). The 1st case was a 74-year-old man who had received liver transplantation. The initial immunosuppressive therapy consisted of cyclosporine and prednisolone. Nine years after transplantation, he was diagnosed as having MDS (RCMD). The 2nd case was a 47-year-old woman who had received cadaveric renal transplantation. The initial immunosuppressive therapy was comprised of cyclosporine, azathioprine, and prednisolone. Twenty-seven years after transplantation, she developed MDS (RA). Both patients received 75 mg/m2AZA once daily for five consecutive days on a 28-day cycle. After 2 courses of therapy, both patients achieved hematological improvement (IWG 2006 criteria) without severe (grade 3/4) non-hematological adverse events. Moreover, AZA did not affect the status of organ transplantation in terms of engraftment and function of the graft. In conclusion, AZA would be a safe and effective agent for patients with MDS after solid organ transplantation. However, long-term follow-up is needed to confirm the safety and efficacy of AZA for patients undergoing solid organ transplantations.