Intravenous cyclosporine and tacrolimus caused anaphylaxis but oral cyclosporine capsules were tolerated in an allogeneic bone marrow transplant recipient
Y. Takamatsu et al., Intravenous cyclosporine and tacrolimus caused anaphylaxis but oral cyclosporine capsules were tolerated in an allogeneic bone marrow transplant recipient, BONE MAR TR, 28(4), 2001, pp. 421-423
Citations number
18
Categorie Soggetti
Hematology,"Medical Research Diagnosis & Treatment
A Japanese female patient with angioimmunoblastic T cell lymphoma underwent
allogeneic bone marrow transplantation (BMT) from her brother. Cyclosporin
e at a dose of 3 mg/kg was started by continuous infusion over 24 h on day
-1 of BMT. Within a couple of minutes after the infusion was begun, she dev
eloped diffuse pruritic erythema on her whole body and tachycardia. The inf
usion was immediately stopped and corticosteroid was given, resulting in di
sappearance of the erythema gradually. She was then switched to intravenous
tacrolimus. However, she suffered urticalial erythema again. Since polyoxy
ethylated castor oil, a solubilizer used in the injective formulation of bo
th cyclosporine and tacrolimus, is considered to be responsible for the rea
ction, she was given oral capsules of cyclosporine (Sandimmun) in which pol
yoxyethylated castor oil was not contained. No further anaphylactic reactio
n was observed. The BM cells were successfully engrafted without causing se
vere GVHD. She was discharged on cyclosporine capsules without any further
adverse effects. Anaphylaxis to intravenous cyclosporine and tacrolimus is
a very rare but a serious complication. Our present case indicates that ora
l capsule of Sandimmun is a safe alternative to prevent GVHD in such a case
of anaphylactic reaction against intravenous formulation.