#05#
Revisiones-Clínica-Diagnóstico
*** Reviews-Clinical-Diagnostics
AGENTES
INMUNOSUPRESORES *** IMMUNOSUPPRESSIVE COMPOUNDS
(Conceptos
/ Keywords: Immunosuppressive comp; Muromonab-cd3; Sirolimus; Tacrolimus;
Cyclosporine; Mycophenolic acid; Antilymphocyte serum; Immunosuppressive comp.
used in oncology, etc).
Enero /
January 2001 --- Marzo / March 2004
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[1]
TÍTULO / TITLE: - Preliminary guidelines
for diagnosing and treating tuberculosis in patients with rheumatoid arthritis
in immunosuppressive trials or being treated with biological agents.
REVISTA
/ JOURNAL: - Ann Rheum Dis 2002 Nov;61 Suppl 2:ii62-3.
AUTORES
/ AUTHORS: - Furst DE; Cush J; Kaufmann S; Siegel J;
Kurth R
INSTITUCIÓN
/ INSTITUTION: - UCLA Medical School, Los Angeles, USA
Presbyterian Hospital, Dallas, USA.
----------------------------------------------------
[2]
TÍTULO / TITLE: - Overcoming restenosis
with sirolimus: from alphabet soup to clinical reality.
REVISTA
/ JOURNAL: - Lancet 2002 Feb 16;359(9306):619-22.
AUTORES
/ AUTHORS: - Poon M; Badimon JJ; Fuster V
INSTITUCIÓN
/ INSTITUTION: - Mount Sinai School of Medicine, 1 Gustav L
Levy Place, Box 1030, New York, NY 10029, USA.
N. Ref:: 34
----------------------------------------------------
[3]
TÍTULO / TITLE: - Treatment of chronic
granulomatous disease with myeloablative conditioning and an unmodified
hemopoietic allograft: a survey of the European experience, 1985-2000.
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2002 Dec 15;100(13):4344-50. Epub 2002 Aug 8.
●●
Enlace al texto completo (gratuito o de pago) 1182/blood-2002-02-0583
AUTORES
/ AUTHORS: - Seger RA; Gungor T; Belohradsky BH;
Blanche S; Bordigoni P; Di Bartolomeo P; Flood T; Landais P; Muller S; Ozsahin
H; Passwell JH; Porta F; Slavin S; Wulffraat N; Zintl F; Nagler A; Cant A;
Fischer A
INSTITUCIÓN
/ INSTITUTION: - European Group for Blood and Marrow
Transplantation (EBMT) and the European Society for Immunodeficiencies (ESID),
Division of Immunology/Hematology, University Children’s Hospital, Zurich,
Switzerland. reinhard.seger@kispi.unizh.ch
RESUMEN
/ SUMMARY: - Treatment of chronic granulomatous disease
(CGD) with myeloablative bone marrow transplantation is considered risky. This
study investigated complications and survival according to different risk
factors present at transplantation. The outcomes of 27 transplantations for
CGD, from 1985 to 2000, reported to the European Bone Marrow Transplant
Registry for primary immunodeficiencies were assessed. Most transplant
recipients were children (n = 25), received a myeloablative busulphan-based
regimen (n = 23), and had unmodified marrow allografts (n = 23) from human
leukocyte antigen (HLA)-identical sibling donors (n = 25). After myeloablative
conditioning, all patients fully engrafted with donor cells; after
myelosuppressive regimens, 2 of 4 patients fully engrafted. Severe (grade 3 or
4) graft-versus-host disease (GVHD) disease developed in 4 patients: 3 of 9
with pre-existing overt infection, 1 of 2 with acute inflammatory disease.
Exacerbation of infection during aplasia was observed in 3 patients;
inflammatory flare at the infection site during neutrophil engraftment in 2:
all 5 patients belonged to the subgroup of 9 with pre-existing infection.
Overall survival was 23 of 27, with 22 of 23 cured of CGD (median follow-up, 2
years). Survival was especially good in patients without infection at the
moment of transplantation (18 of 18). Pre-existing infections and inflammatory
lesions have cleared in all survivors (except in one with autologous
reconstitution). Myeloablative conditioning followed by transplantation of
unmodified hemopoietic stem cells, if performed at the first signs of a severe
course of the disease, is a valid therapeutic option for children with CGD
having an HLA-identical donor. N.
Ref:: 30
----------------------------------------------------
[4]
TÍTULO / TITLE: - Drug immunosuppression
therapy for adult heart transplantation. Part 2: clinical applications and
results.
REVISTA
/ JOURNAL: - Ann Thorac Surg 2004 Jan;77(1):363-71.
AUTORES
/ AUTHORS: - Mueller XM
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiovascular Surgery,
Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. xavier.mueller@usherbrooke.ca
RESUMEN
/ SUMMARY: - This review describes the clinical
application of classical immunosuppressive drugs as well as that of more recent
drugs. All current immunosuppressive drugs target T-cell activation, and
cytokine production and clonal expansion, or both. Immunosuppressive protocols
can be broadly divided into induction therapy, maintenance immunosuppression,
and treatment of acute rejection episodes.
N. Ref:: 82
----------------------------------------------------
[5]
TÍTULO / TITLE: - Renal transplantation:
can we reduce calcineurin inhibitor/stop steroids? Evidence based on protocol
biopsy findings.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Mar;14(3):755-66.
AUTORES
/ AUTHORS: - Gotti E; Perico N; Perna A; Gaspari F;
Cattaneo D; Caruso R; Ferrari S; Stucchi N; Marchetti G; Abbate M; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and
Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for
Pharmacological Research, Italy.
RESUMEN
/ SUMMARY: - How to combine antirejection drugs and
which is the optimal dose of steroids and calcineurin inhibitors beyond the
first year after kidney transplantation to maintain adequate immunosuppression
without major side effects are far from clear. Kidney transplant patients on
steroid, cyclosporine (CsA), and azathioprine were randomized to per-protocol
biopsy (n = 30) or no-biopsy (n = 29) 1 to 2 yr posttransplant. Steroid or CsA
were discontinued or reduced on the basis of biopsy to establish effects on
drug-related complications, acute rejection, and graft function over 3 yr of
follow-up. Serum creatinine, GFR (plasma clearance of iohexol), RPF (renal
clearance of p-aminohippurate), CsA pharmacokinetics, and adverse events were
monitored yearly. At the end, patients underwent a second biopsy. Per-protocol
biopsy histology revealed no lesions (n = 5, steroid withdrawal), CsA
nephropathy (n = 13, CsA discontinuation/reduction), or chronic rejection (n =
12, standard therapy). Reducing the drug regimen led to overall fewer side
effects related to immunosuppression as compared with standard therapy or
no-biopsy. Steroids were safely stopped with no acute rejection or graft loss.
Complete CsA discontinuation was associated with acute rejection in the first four
patients. Lowering CsA to low target CsA trough (30 to 70 ng/ml) never led to
acute rejection or major renal function deterioration. Biopsy patients on
conventional regimen had no acute rejection, one graft loss, no significant
change in GFR, and significant RPF decline. No-biopsy controls: no acute
rejection, one graft loss, significant decline of GFR and RPF. By serial biopsy
analysis, severe lesions did not develop in patients with steroid
discontinuation in contrast to patients on standard therapy over follow-up. CsA
reduction did not adversely affect histology. Per-protocol biopsy more than 1
yr after kidney transplantation is a safe procedure to guide change of drug
regimen and to lower the risk of major side effects.
----------------------------------------------------
[6]
TÍTULO / TITLE: - Drug immunosuppression
therapy for adult heart transplantation. Part 1: immune response to allograft
and mechanism of action of immunosuppressants.
REVISTA
/ JOURNAL: - Ann Thorac Surg 2004 Jan;77(1):354-62.
AUTORES
/ AUTHORS: - Mueller XM
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiovascular Surgery,
Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. xavier.mueller@usherbrooke.ca
RESUMEN
/ SUMMARY: - In the early days of transplantation,
immunosuppression therapy was rather broad and nonspecific, mainly using
high-dose corticosteroids and azathioprine. Thereafter we progressively
narrowed the target of immunosuppressive strategy starting with polyclonal
antibodies. The introduction of cyclosporine, OKT3, and tacrolimus further
narrowed the target on the T-cell pathways. More recently mycophenolate mofetil
progressively took the place of azathioprine with its higher lymphocyte specificity
and sirolimus and interleukin-2 receptor antibodies were introduced. In this
field in constant movement the aim is to find a drug or a regimen that provides
optimal immunosuppression therapy with minimal side effects, in other words to
find the right balance between overimmunosuppression and underimmunosuppression
therapy. This review is divided into two parts. The first part will provide a
basic understanding of the immunologic response to allograft and explain how
conventional and recently introduced immunosuppressive agents work. The second
part will describe the clinical application of immunosuppressive drugs to
provide practical information for those in charge of heart transplant
recipients. N. Ref:: 68
----------------------------------------------------
[7]
TÍTULO / TITLE: - Cyclosporin trough
levels: is monitoring necessary during short-term treatment in psoriasis? A
systematic review and clinical data on trough levels.
REVISTA
/ JOURNAL: - Br J Dermatol 2002 Jul;147(1):122-9.
AUTORES
/ AUTHORS: - Heydendael VM; Spuls PI; Ten Berge IJ;
Opmeer BC; Bos JD; de Rie MA
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, Academic
Medical Center, University of Amsterdam, PO Box 22660, the Netherlands.
RESUMEN
/ SUMMARY: - BACKGROUND: Cyclosporin is an effective
treatment for severe plaque psoriasis. Unfortunately, its use may be limited by
time- and dose-related nephrotoxicity. Serum trough levels may be useful for
monitoring the risk of nephrotoxicity. OBJECTIVES: To determine whether monitoring
of trough levels is necessary in psoriasis patients undergoing short-term
treatment with cyclosporin. METHODS: A computerized and manual literature
search identified studies on adults with plaque-type psoriasis treated with
cyclosporin < or = 5 mg kg-1 daily, in which trough levels were measured in
whole blood. Number of patients, treatment duration, formulation and dosage,
renal function tests and trough levels were extracted. The association between
renal function and trough levels was investigated. Additionally, in a
randomized controlled trial on cyclosporin vs. methotrexate in moderate to
severe psoriasis, cyclosporin trough levels were measured frequently in 20
patients during 12 weeks of treatment. The Pearson correlation coefficient
between serum creatinine and cyclosporin trough levels was calculated. RESULTS:
Fifty-six articles were found concerning cyclosporin trough level measurements
in psoriasis patients, of which eight were analysed. Many studies were excluded
due to inappropriate cyclosporin dosages used. As data were heterogeneous and
lacked various key parameters, a correlation study and a meta-analysis could
not be performed. Instead, a quantitative description of the literature was
given. No high mean trough levels or elevations of serum creatinine were
described. In our clinical study, all the mean trough levels in 17 patients
treated with cyclosporin 3 mg kg-1 daily were within the therapeutic range
(< 200 ng mL-1). Elevated trough levels were found in two of three patients
treated with cyclosporin 3-5 mg kg-1 daily. No signs of renal dysfunction were
seen. CONCLUSIONS: The literature does not provide a definitive answer on
whether monitoring cyclosporin trough levels in patients with psoriasis should
be standard practice. Our own data show no need for cyclosporin trough level
monitoring during short-term treatment with cyclosporin 3 mg kg-1 daily.
However, when cyclosporin doses are > 3 mg kg-1 daily, monitoring may be
indicated. N. Ref:: 32
----------------------------------------------------
[8]
TÍTULO / TITLE: - Subcutaneous
panniculitic T-cell lymphoma in children: response to combination therapy with
cyclosporine and chemotherapy.
REVISTA
/ JOURNAL: - J Am Acad Dermatol 2004 Feb;50(2
Suppl):S18-22.
●●
Enlace al texto completo (gratuito o de pago) 1016/S0190
AUTORES
/ AUTHORS: - Shani-Adir A; Lucky AW; Prendiville J;
Murphy S; Passo M; Huang FS; Paller AS
INSTITUCIÓN
/ INSTITUTION: - Division of Dermatology, Children’s
Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614, USA.
RESUMEN
/ SUMMARY: - We describe 2 adolescent boys with facial
swelling and/or subcutaneous nodules and fever. Extensive evaluation, including
several biopsy specimens, led to a diagnosis of subcutaneous panniculitic
T-cell lymphoma, an entity rarely seen in children. Both patients were treated
with oral cyclosporine in an effort to suppress the cytokine release from
T-cells that has been thought to induce the hemophagocytic syndrome. The
patients responded dramatically to cyclosporine treatment with defervescence of
the fever and reduction in number and size of the subcutaneous nodules.
Subsequent therapy with multidrug chemotherapy achieved complete remission in
the first patient. This report suggests the value of cyclosporine as a
first-line agent coupled with chemotherapy in the treatment of patients with
subcutaneous panniculitic T-cell lymphoma. A clinicopathologic review of 8
described pediatric cases of subcutaneous panniculitic T-cell lymphoma is also
presented. N. Ref:: 15
----------------------------------------------------
[9]
TÍTULO / TITLE: - Patient management by
Neoral C(2) monitoring: an international consensus statement.
REVISTA
/ JOURNAL: - Transplantation 2002 May 15;73(9
Suppl):S12-8.
AUTORES
/ AUTHORS: - Levy G; Thervet E; Lake J; Uchida K
INSTITUCIÓN
/ INSTITUTION: - Multiorgan Transplant Program, Toronto
General Hospital, 621 University Avenue, 10NU-116, Toronto, Ontario M5G 2C4,
Canada. N. Ref:: 36
----------------------------------------------------
[10]
TÍTULO / TITLE: - Immunoablation followed
or not by hematopoietic stem cells as an intense therapy for severe autoimmune
diseases. New perspectives, new problems.
REVISTA
/ JOURNAL: - Haematologica. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://db.doyma.es/
●●
Cita: Haematologica: <> 2001 Apr;86(4):337-45.
AUTORES
/ AUTHORS: - Marmont AM N. Ref:: 127
----------------------------------------------------
[11]
TÍTULO / TITLE: - Inflammatory
myopathies: clinical, diagnostic and therapeutic aspects.
REVISTA
/ JOURNAL: - Muscle Nerve 2003 Apr;27(4):407-25.
●●
Enlace al texto completo (gratuito o de pago) 1002/mus.10313
AUTORES
/ AUTHORS: - Mastaglia FL; Garlepp MJ; Phillips BA;
Zilko PJ
INSTITUCIÓN
/ INSTITUTION: - Centre for Neuromuscular and Neurological
Disorders, University of Western Australia, Queen Elizabeth II Medical Centre,
Nedlands, Australia. flmast@cyllene.uwa.edu.au
RESUMEN
/ SUMMARY: - The three major forms of immune-mediated
inflammatory myopathy are dermatomyositis (DM), polymyositis (PM), and
inclusion-body myositis (IBM). They each have distinctive clinical and
histopathologic features that allow the clinician to reach a specific diagnosis
in most cases. Magnetic resonance imaging is sometimes helpful, particularly if
the diagnosis of IBM is suspected but has not been formally evaluated. Myositis-specific
antibodies are not helpful diagnostically but may be of prognostic value; most
antibodies have low sensitivity. Muscle biopsy is mandatory to confirm the
diagnosis of an inflammatory myopathy and to allow unusual varieties such as
eosinophilic, granulomatous, and parasitic myositis, and macrophagic
myofasciitis, to be recognized. The treatment of the inflammatory myopathies
remains largely empirical and relies upon the use of corticosteroids,
immunosuppressive agents, and intravenous immunoglobulin, all of which have
nonselective effects on the immune system. Further controlled clinical trials
are required to evaluate the relative efficacy of the available therapeutic
modalities particularly in combinations, and of newer immunosuppressive agents (mycophenolate
mofetil and tacrolimus) and cytokine-based therapies for the treatment of
resistant cases of DM, PM, and IBM. Improved understanding of the molecular
mechanisms of muscle injury in the inflammatory myopathies should lead to the
development of more specific forms of immunotherapy for these conditions. N. Ref:: 256
----------------------------------------------------
[12]
TÍTULO / TITLE: - How should the
immunosuppressive regimen be managed in patients with established chronic
allograft failure?
REVISTA
/ JOURNAL: - Kidney Int Suppl 2002 May;(80):68-72.
AUTORES
/ AUTHORS: - Danovitch GM
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, UCLA School of
Medicine, USA. gdanovitch@mednet.ucla.edu N. Ref:: 25
----------------------------------------------------
[13]
TÍTULO / TITLE: - Steroid-resistant
kidney transplant rejection: diagnosis and treatment.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2001 Feb;12 Suppl
17:S48-52.
AUTORES
/ AUTHORS: - Bock HA
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, Kantonsspital,
Aarau, Switzerland. bock@ksa.ch
RESUMEN
/ SUMMARY: - Decreases in transplant function may be
attributable to a variety of conditions, including prerenal and postrenal
failure, cyclosporin A (CsA) toxicity, polyoma nephritis, recurrent
glomerulonephritis, and rejection. The diagnosis of rejection should therefore
be made on the basis of a transplant biopsy of adequate size, before the
initiation of any therapy. Pulse steroid treatment (three to five 0.25- to
1.0-g pulses of methylprednisolone, administered intravenously) is the usual
first-line therapy and has a 60 to 70% success rate, although orally
administered prednisone (0.25 g) may be just as efficacious. Even if reverted,
any rejection should trigger an at least temporary increase in basal
immunosuppression, consisting of an increase in CsA or tacrolimus target
levels, the addition of steroids or an increase in their dosage, the addition
of mycophenolate mofetil, or a switch from CsA to tacrolimus. The addition of
rapamycin or its RAD derivative may fulfill the same purpose. Steroid
resistance should not be assumed before the fifth day of pulse steroid
treatment, although histologic features of vascular rejection may indicate the
need for more aggressive treatment earlier. Steroid-resistant rejection is
traditionally treated with poly- or monoclonal antilymphocytic antibodies, with
success rates of 60 to 70%. Their potential benefit must be carefully balanced
against the risks of infection and lymphoma. More recently, mycophenolate
mofetil has been successfully used to treat steroid-resistant rejection, but
only of the interstitial (cellular) type. Switching from CsA to tacrolimus for
treating recurrent or antibody-resistant rejection is successful in
approximately 60% of cases. Plasmapheresis and intravenously administered Ig
have been used in some desperate cases, with surprising success. Because none
of the available drugs has a significantly better profile of therapeutic versus
adverse effects, the possible benefits of continued rejection therapy must be
continuously balanced with the potential for serious, sometimes fatal, side
effects. N. Ref:: 35
----------------------------------------------------
[14]
TÍTULO / TITLE: - Pharmacokinetic,
pharmacodynamic, and outcome investigations as the basis for mycophenolic acid
therapeutic drug monitoring in renal and heart transplant patients.
REVISTA
/ JOURNAL: - Clin Biochem 2001 Feb;34(1):17-22.
AUTORES
/ AUTHORS: - Shaw LM; Korecka M; DeNofrio D; Brayman KL
INSTITUCIÓN
/ INSTITUTION: - Departments of Pathology & Laboratory
Medicine and Surgery, University of Pennsylvania Medical Center, Philadelphia,
PA, USA. shawlmj@mail.med.upenn.edu
RESUMEN
/ SUMMARY: - Mycophenolate mofetil is widely used in
combination with either cyclosporine or tacrolimus for rejection prophylaxis in
renal and heart transplant patients. Although not monitored routinely nearly to
the degree that other agents such as cyclosporine or tacrolimus, there is an
expanding body of experimental evidence for the utility of monitoring
mycophenolic acid, the primary active metabolite of mycophenolate mofetil,
plasma concentration as an index of risk for the development of acute
rejection. The following are important experimentally-based reasons for
recommending the incorporation of target therapeutic concentration monitoring
of mycophenolic acid: (1) the MPA dose-interval area-under-the-concentration-time
curve, and less precisely, MPA predose concentrations predict the risk for
development of acute rejection; (2) the strong correlation between mycophenolic
acid plasma concentrations and expression of important cell surface activation
antigens, whole blood pharmacodynamic assays of lymphocyte proliferation and
median graft rejection scores in a heart transplant animal model; (3) the
greater than 10-fold interindividual variation of MPA area under the
concentration time curve values in heart and renal transplant patients
receiving a fixed dose of the parent drug; (4) drug-drug interactions involving
other immunosuppressives are such that when switching from one to another (eg,
from cyclosporine to tacrolimus or vice-versa) substantial changes in MPA concentrations
can occur in patients receiving a fixed dose of the parent drug; (5)
significant effects of liver and kidney diseases on the steady-state total and
free mycophenolic acid area under the concentration time curve values; (6) the
need to closely monitor mycophenolic acid when a major change in
immunosuppression is planned such as steroid withdrawal. Current investigations
are focused on determination of the most optimal sampling time and for
mycophenolic acid target therapeutic concentration monitoring. Further
investigations are needed to evaluate the pharmacologic activity of the newly
described acyl glucuronide metabolite of mycophenolic acid which has been shown
to inhibit, in vitro, inosine monophosphate dehydrogenase. N. Ref:: 37
----------------------------------------------------
[15]
TÍTULO / TITLE: - Clinical validation
studies of Neoral C(2) monitoring: a review.
REVISTA
/ JOURNAL: - Transplantation 2002 May 15;73(9
Suppl):S3-11.
AUTORES
/ AUTHORS: - Nashan B; Cole E; Levy G; Thervet E
INSTITUCIÓN
/ INSTITUTION: - Klinik fur Viszeral und
Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.
1, D-30625 Hannover, Germany. N.
Ref:: 34
----------------------------------------------------
[16]
TÍTULO / TITLE: - European best practice
guidelines for renal transplantation. Section IV: Long-term management of the
transplant recipient. IV.2.1 Differential diagnosis of chronic graft
dysfunction.
REVISTA
/ JOURNAL: - Nephrol Dial Transplant. Acceso gratuito
al texto completo a partir de los 2 años de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://ndt.oupjournals.org/
●●
Cita: Nephrology Dialysis Transplantation: <> 2002;17 Suppl 4:4-8.
RESUMEN
/ SUMMARY: - GUIDELINES: A. Any significant
deterioration in graft function should be investigated using the appropriate
diagnostic tools and, if possible, therapeutic interventions should be
initiated. The usual causes of a decline in glomerular filtration rate after
the first year include transplant-specific causes such as chronic allograft
nephropathy, acute rejection episodes, chronic calcineurin inhibitor
nephrotoxicity, transplant renal artery stenosis and ureteric obstruction, as
well as immunodeficiency-related causes and non-transplant-related causes, such
as recurrent or de novo renal diseases and bacterial infections. B. Any new
onset and persistent proteinuria of >0.5 g/24 h should be investigated and
therapeutic interventions should be initiated. The usual causes include chronic
allograft nephropathy and transplant glomerulopathy, and recurrent or de novo
glomerulonephritis.
----------------------------------------------------
[17]
TÍTULO / TITLE: - Treatment responses of
childhood aplastic anaemia with chromosomal aberrations at diagnosis.
REVISTA
/ JOURNAL: - Br J Haematol 2002 Jul;118(1):313-9.
AUTORES
/ AUTHORS: - Ohga S; Ohara A; Hibi S; Kojima S; Bessho
F; Tsuchiya S; Ohshima Y; Yoshida N; Kashii Y; Nishimura S; Kawakami K;
Nishikawa K; Tsukimoto I
INSTITUCIÓN
/ INSTITUTION: - Aplastic Anaemia Committee of the Japanese
Society of Paediatric Haematology, Tokyo, Japan. ohgas@pediatr.med.kyushu-u.ac.jp
RESUMEN
/ SUMMARY: - The clinical outcome of childhood aplastic
anaemia (AA) with aberrant cytogenetic clones at diagnosis was surveyed. Among
198 children with newly diagnosed AA registered with the AA Committee of the
Japanese Society of Paediatric Hematology between 1994 and 1998, cytogenetic
studies of bone marrow (BM) cells were completed in 159 patients. Apart from
one Robertsonian translocation, seven patients (4.4%) showed clonal chromosomal
abnormalities in hypoplastic BM without myelodysplastic features. The patients
included six girls and one boy with a median age of 11 years (range 5-14 years).
Six patients had del(6), del(5), del(13), del(20), or -7, and one showed
add(9). Four patients responded to the first immunosuppressive therapy (IST:
cyclosporin A plus anti-thymocyte globulin) and one obtained a spontaneous
remission. Cytogenetic abnormalities remained in two patients with an IST
response. On the other hand, two patients showed no IST response. One did not
respond to repeat IST and died of acute graft-versus-host disease after an
unrelated-BM transplant. Another obtained a complete response after a
successful BM transplant. No haematological findings at diagnosis predicted the
treatment response. No significant morphological changes developed during the
course of the illness. A literature review revealed that half of 24 AA patients
with chromosomal abnormalities responded to the first IST, and that +6 was the
sole predictable marker for IST unresponsiveness. These results suggest that
IST can be applied as the initial therapy for AA with cytogenetic abnormalities
in the absence of completely matched donors.
N. Ref:: 32
----------------------------------------------------
[18]
TÍTULO / TITLE: - International
Federation of Clinical Chemistry/International Association of Therapeutic Drug
Monitoring and Clinical Toxicology working group on immunosuppressive drug
monitoring.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):59-67.
AUTORES
/ AUTHORS: - Holt DW; Armstrong VW; Griesmacher A;
Morris RG; Napoli KL; Shaw LM
INSTITUCIÓN
/ INSTITUTION: - Analytical Unit, St George’s Hospital
Medical School, London, UK. d.holt@sghms.ac.uk
RESUMEN
/ SUMMARY: - Issues surrounding the measurement and
interpretation of immunosuppressive drug concentrations have been summarized in
a number of consensus documents. The Scientific Division of the International
Federation of Clinical Chemistry has formed a working group in collaboration
with the International Association of Therapeutic Drug Monitoring and Clinical
Toxicology. This paper sets out the goals of the working group in light of the
developments that have occurred in the field of immunosuppressive drug
monitoring since the publication of the last consensus documents.
----------------------------------------------------
[19]
TÍTULO / TITLE: - Controlling the
incidence of infection and malignancy by modifying immunosuppression.
REVISTA
/ JOURNAL: - Transplantation 2001 Dec 27;72(12
Suppl):S89-93.
AUTORES
/ AUTHORS: - Soulillou JP; Giral M
RESUMEN
/ SUMMARY: - Long-term outcomes in renal transplantation
have improved over the years but are still a matter of concern. Because
patients typically require lifelong immunosuppression, the risks of cancer and
infection associated with immunosuppressive agents continue to demand
attention. Physicians strive endlessly to find the right balance between the
level of immunosuppression required to prevent rejection and the level that
will minimize dose-dependent side effects. Data presented in this paper suggest
that some renal transplant recipients might have more than necessary
immunosuppression during maintenance therapy and that reducing the
immunosuppressant dose can decrease cancer incidence, without worsening
long-term patient or allograft survival. Additionally, data were examined
suggesting that immunosuppressive agents might be associated with different
risks for cancer, specifically, the potential advantage of reduced cancer risk
for sirolimus and sirolimus derivatives in comparison with standard
immunosuppressive agents. Although promising, these preliminary results are
from preclinical studies, and further study is warranted. N. Ref:: 42
----------------------------------------------------
[20]
TÍTULO / TITLE: - Guidelines for the
diagnosis and management of acquired aplastic anaemia.
REVISTA
/ JOURNAL: - Br J Haematol 2003 Dec;123(5):782-801.
AUTORES
/ AUTHORS: - Marsh JC; Ball SE; Darbyshire P;
Gordon-Smith EC; Keidan AJ; Martin A; McCann SR; Mercieca J; Oscier D; Roques
AW; Yin JA
INSTITUCIÓN
/ INSTITUTION: - St. George’s Hospital Medical School, London,
UK. janice@bshhya.demon.co.uk
----------------------------------------------------
[21]
TÍTULO / TITLE: - A retrospective review
of sirolimus (Rapamune) therapy in orthotopic liver transplant recipients
diagnosed with chronic rejection.
REVISTA
/ JOURNAL: - Liver Transpl 2003 May;9(5):477-83.
●●
Enlace al texto completo (gratuito o de pago) 1053/jlts.2003.50119
AUTORES
/ AUTHORS: - Neff GW; Montalbano M; Slapak-Green G;
Berney T; Bejarano PA; Joshi A; Icardi M; Nery J; Seigo N; Levi D; Weppler D;
Pappas P; Ruiz J; Schiff ER; Tzakis AG
INSTITUCIÓN
/ INSTITUTION: - University of Miami, Department of
Medicine, Miami, FL 33136, USA. gneff@med.miami.edu
RESUMEN
/ SUMMARY: - Treatment options are limited for
orthotopic liver transplant (OLT) recipients suffering from chronic rejection
(CR). We performed a retrospective review of OLT recipients diagnosed with CR
and treated with sirolimus. The medical records of all OLT recipients treated
with sirolimus between October, 1998 and October, 2000 were retrospectively
reviewed. The diagnosis of CR was made by both clinical and histologic
criteria: bile duct to hepatic artery ratio less than 0.7, histologic activity
index, hepatic arterial wall thickening, and chronic elevation of liver
chemistries. Two groups were defined in regard to sirolimus response: sirolimus
responders (SR) and sirolimus nonresponders (SNR). Response to treatment was
granted only when patients were found to have resolution of abnormal liver
transaminases and an improvement in hepatic artery to bile duct ratio. Serum
collections for liver chemistries were collected on days 1, 30, 60, and 90.
Liver biopsies were reviewed in blinded fashion from day 1 and at least 180
days on therapy by double-blinded pathologists. Sirolimus-related complications
were recorded and include drug toxicity, anemia with and without treatment,
hospitalizations, infections, immunosuppression complications, lipid profile
disorders, edema, muscle aches, and gastrointestinal complaints. Twenty-one
patients were diagnosed with CR. The SR group included 13 of 21, and 8 of 21
were in the SNR group. Anemia was diagnosed in 12 of 21 patients: SR, 7 of 13;
SNR, 5 of 8; with 5 patients requiring red blood cell transfusions (2 SR, 3
SNR). Recombinant erythropoietin was started in 5 of 21 patients. Sirolimus
serum levels were found to be greater than 20 ng/dL in 12 patients. Sirolimus
was discontinued in 9 patients,
----------------------------------------------------
[22]
TÍTULO / TITLE: - Effective prophylactic
protocol in delayed hypersensitivity to contrast media: report of a case
involving lymphocyte transformation studies with different compounds.
REVISTA
/ JOURNAL: - Radiology. Acceso gratuito al texto
completo a partir de los 2 años de la publicación; - http://radiology.rsnajnls.org/
●●
Cita: Radiology: <> 2002 Nov;225(2):466-70.
AUTORES
/ AUTHORS: - Romano A; Artesani MC; Andriolo M; Viola
M; Pettinato R; Vecchioli-Scaldazza A
INSTITUCIÓN
/ INSTITUTION: - Department of Internal Medicine and
Geriatrics, Universita’ Cattolica del Sacro Cuore, Allergy Unit, Complesso
Integrato Columbus, Via G. Moscati 31, 00168 Rome, Italy. columbus.allerg@linet.it
RESUMEN
/ SUMMARY: - A patient with maculopapular reactions to
iopamidol needed to undergo angiography for a cerebral arteriovenous
malformation. In vivo and in vitro tests were performed with ionic and nonionic
contrast media, including iopamidol and iobitridol. All results were positive,
demonstrating delayed hypersensitivity. The patient received
6-alpha-methylprednisolone and cyclosporine 1 week before and 2 weeks after
four angiograms were obtained with the use of iobitridol, which was well
tolerated.
----------------------------------------------------
[23]
TÍTULO / TITLE: - Persistent remission
after immunosuppressive therapy of hairy cell leukemia mimicking aplastic
anemia: two case reports.
REVISTA
/ JOURNAL: - Int J Hematol 2003 May;77(4):391-4.
AUTORES
/ AUTHORS: - Sugimori C; Kaito K; Nakao S
INSTITUCIÓN
/ INSTITUTION: - Cellular Transplantation Biology, Kanazawa
University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan.
RESUMEN
/ SUMMARY: - Some patients with hairy cell leukemia
(HCL) manifest pancytopenia and bone marrow hypoplasia without an apparent
increase in atypical cells, so their disease resembles severe aplastic anemia
at onset. We treated 2 HCL patients, who were initially diagnosed with aplastic
anemia, with antithymocyte globulin (ATG) in combination with cyclosporine or
antilymphocyte globulin (ALG). Both patients obtained partial remission in
response to the immunosuppressive therapy and did not need transfusion
treatment for more than 3 years. Sustained improvement of hematopoiesis in such
B-cell malignancies after ATG/ ALG therapy suggests that the mechanisms
underlying successful immunosuppressive therapy for aplastic anemia may involve
B-cell suppression, inhibiting hematopoietic stem cells. N. Ref:: 18
----------------------------------------------------
[24]
TÍTULO / TITLE: - Histopathological study
of intrahepatic islets transplanted in the nonhuman primate model using
edmonton protocol immunosuppression.
REVISTA
/ JOURNAL: - J Clin Endocrinol Metab. Acceso gratuito
al texto completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://jcem.endojournals.org/
●●
Cita: J. of Clin Endocrinol & Metab: <> 2002 Dec;87(12):5424-9.
AUTORES
/ AUTHORS: - Hirshberg B; Mog S; Patterson N; Leconte
J; Harlan DM
INSTITUCIÓN
/ INSTITUTION: - Transplantation and Autoimmunity Branch,
National Institute of Diabetes and Digestive and Kidney Diseases, National
Institutes of Health, Bethesda, Maryland 20892, USA.
RESUMEN
/ SUMMARY: - While islet cell transplantation is a promising
way to restore insulin independence to patients with type I diabetes mellitus,
a detailed histological analysis of the transplanted, intraportal islets has
not yet been reported. Rhesus macaques underwent total pancreatectomy, then had
allogeneic isolated islets infused into their portal vein, followed by
daclizumab, tacrolimus, and sirolimus to prevent islet rejection. Islets were
evenly distributed among the liver lobes. Liver sections from a primate given
allogeneic islets 5 d earlier did not display any islet capillary formation,
whereas intrahepatic islets transplanted 30 and 90 d before euthanasia showed
an abundant capillary supply. Localized hepatocellular glycogenosis was
observed surrounding the islets in a primate with functioning islets 7 months
post transplant. Liver sections from a primate that rejected islets
transplanted 2 months prior displayed only islet remnants with prominent local
lymphohistiocytic inflammation and an occasional capillary. We conclude that
islets develop an abundant vascular supply within 30 d following transplant and
because capillaries persist even following rejection, that the vascular cells
are likely from the recipient. While transplanted islets were not vascularized
early post transplant, the primates remained insulin independent. The long-term
consequence of islets in the liver, marked by the glycogenosis, remains unknown
and warrants further study.
----------------------------------------------------
[25]
TÍTULO / TITLE: - Resolution of oral
non-Hodgkin’s lymphoma by reduction of immunosuppressive therapy in a renal
allograft recipient: a case report and review of the literature.
REVISTA
/ JOURNAL: - Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2002 Dec;94(6):697-701.
●●
Enlace al texto completo (gratuito o de pago) 1067/moe.2002.126889
AUTORES
/ AUTHORS: - Keogh PV; Fisher V; Flint SR
INSTITUCIÓN
/ INSTITUTION: - Department of Oral Surgery, Oral Medicine
and Oral Pathology, Dublin Dental School and Hospital, Trinity College,
Ireland. pakeogh@dental.tcd.ie
RESUMEN
/ SUMMARY: - A case of oral non-Hodgkin’s lymphoma
arising in a patient with insulin-dependent diabetes who had undergone renal
allograft transplantation is described. The resolution of the disease was
achieved by a reduction in her immunosuppressive therapy. The differential
diagnosis is discussed, and the management of posttransplantation lymphoproliferative
disorders is reviewed. N.
Ref:: 40
----------------------------------------------------
[26]
TÍTULO / TITLE: - The cytology of
HIV-induced immunosuppression. Changing pattern of disease in the era of highly
active antiretroviral therapy.
REVISTA
/ JOURNAL: - Cytopathology 2001 Oct;12(5):281-96.
AUTORES
/ AUTHORS: - Kocjan G; Miller R
INSTITUCIÓN
/ INSTITUTION: - Department of Histopathology, Royal Free
and University College Medical School, University College London, UK. N. Ref:: 89
----------------------------------------------------
[27]
TÍTULO / TITLE: - Therapeutic drug
monitoring of immunosuppressant drugs in clinical practice.
REVISTA
/ JOURNAL: - Clin Ther 2002 Mar;24(3):330-50;
discussion 329.
AUTORES
/ AUTHORS: - Kahan BD; Keown P; Levy GA; Johnston A
INSTITUCIÓN
/ INSTITUTION: - Division of Immunology and Organ
Transplantation, University of Texas Health Science Center at Houston Medical
School, 77030, USA. Barry.D.Kahan@uth.tmc.edu
RESUMEN
/ SUMMARY: - BACKGROUND: Therapeutic drug monitoring
(TDM) is essential to maintain the efficacy of many immunosuppressant drugs
while minimizing their toxicity. TDM has become more refined with the
development of new monitoring techniques and more specific assays. OBJECTIVE:
This article summarizes current data on TDM of the following immunosuppressant
drugs used in organ transplantation: cyclosporine, tacrolimus, sirolimus,
everolimus, and mycophenolate mofetil. METHODS: Published data were identified
by a MEDLINE search of the English-language literature through March 2001 using
the terms therapeutic drug monitoring, cyclosporine, tacrolimus, sirolimus,
everolimus, and mycophenolate mofetil. Relevant conference abstracts were also
included. RESULTS: TDM of cyclosporine has been well studied, and recent
findings indicate that monitoring of drug levels 2 hours after dosing is a more
sensitive predictor of outcome than trough (C0) monitoring. C0 levels are being
used more widely in TDM of tacrolimus; however, the relationship between C0 and
area under the curve has varied widely in clinical trials, with correlations
ranging from 0.11 to 0.92. The use of TDM of sirolimus, everolimus, and
mycophenolate mofetil is evolving rapidly. CONCLUSIONS: TDM of immunosuppressant
drugs that have a narrow therapeutic index is an increasingly useful tool for
minimizing drug toxicity while maximizing prevention of graft loss and organ
rejection. N. Ref:: 85
----------------------------------------------------
[28]
TÍTULO / TITLE: - Autoimmune bullous
dermatoses in the elderly: diagnosis and management.
REVISTA
/ JOURNAL: - Drugs Aging 2003;20(9):663-81.
AUTORES
/ AUTHORS: - Mutasim DF
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, University of
Cincinnati, College of Medicine, Cincinnati, Ohio, USA. diya.mutasim@uc.edu
RESUMEN
/ SUMMARY: - Elderly individuals are susceptible to
autoimmune bullous dermatoses (in particular, pemphigoid, epidermolysis bullosa
acquisita and paraneoplastic pemphigus). Bullous dermatoses are associated with
high morbidity and mortality. Bullous dermatoses result from autoimmune
responses to one or more components of the basement membrane or desmosomes.
Pemphigoid results from autoimmunity to hemidesmosomal proteins present in the
basement membrane of stratified squamous epithelia. Patients present with tense
blisters in flexural areas of the skin. Mild or moderate bullous pemphigoid may
be treated with potent topical corticosteroids while extensive disease usually
requires systemic corticosteroids or systemic immunosuppressive agents such as
azathioprine. Mucosal pemphigoid affects one or more mucous membranes that are
lined by stratified squamous epithelia. The two most commonly involved sites
are the eye and the oral cavity. Lesions frequently result in scar formation,
which may cause blindness. Patients with severe disease or ocular involvement
require aggressive therapy with corticosteroids and cyclophosphamide.
Epidermolysis bullosa acquisita results from autoimmunity to type VII collagen
in the anchoring fibrils of the basement membrane area. Lesions may either
arise on an inflammatory base or be non-inflammatory and result primarily from
trauma. The inflammatory type of the disease is more responsive to therapy than
the non-inflammatory type. Treatment options include corticosteroids, dapsone,
cyclosporin, plasmapheresis and immunoglobulin G. Paraneoplastic pemphigus
results from autoimmunity to multiple antigens within the desmosomes. The
disorder is associated with neoplasms, especially leukaemia and lymphoma.
Patients present with severe stomatitis and polymorphous skin eruption. The
mucosal and cutaneous involvement may respond to successful treatment of the
underlying neoplasm or may require immunosuppressive therapy. N. Ref:: 122
----------------------------------------------------
[29]
TÍTULO / TITLE: - B19 virus infection in
renal transplant recipients.
REVISTA
/ JOURNAL: - J Clin Virol. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.elsevier.com/gej-ng/29/46/32/show/Products/VIRUSINT/index.htt
●●
Cita: J Clinical Virology: <> 2003 Apr;26(3):361-8.
AUTORES
/ AUTHORS: - Cavallo R; Merlino C; Re D; Bollero C;
Bergallo M; Lembo D; Musso T; Leonardi G; Segoloni GP; Ponzi AN
INSTITUCIÓN
/ INSTITUTION: - Virology Unit, Department of Public Health
and Microbiology, University of Turin, Via Santena 9, 10126, Turin, Italy. rossana.cavallo@unito.it
RESUMEN / SUMMARY: - BACKGROUND: B19 virus infection with persistent anaemia has been reported in organ transplant recipients. Detection of B19 virus DNA in serum is the best direct marker of active infection. OBJECTIVE: The present study evaluated the incidence and clinical role of active B19 virus infection in renal transplant recipients presenting with anaemia. STUDY DESIGN: Forty-eight such recipients were investigated by nested PCR on serum samples. The controls were 21 recipients without anaemia. Active HCMV infection was also investigated as a marker of high immunosuppression. RESULTS AND CONCLUSIONS: In 11/48 (23%) patients B19 virus DNA was demonstrated in serum versus only 1/21 (5%) of the controls. Ten of these 11 patients had already been seropositive at transplantation and active infection occurred in eight of them during the first 3 months after transplantation. The remaining patient experienced a primary infection 9 months after transplantation. Eight (73%) of these 11 patients displayed a concomitant HCMV infection and four (36%) showed increasing serum crea