Cyclosporin A (CsA) was used as an immunosuppressant in 5 leukemia patients receiving allogeneic bone marrow transplantation. In cases 1 and 2, CsA was given for preventing graft versus host disease (GVHD) in doses of 10 mg/kg/day and 11.5 mg/kg/day, respectively, by continuous intravenous infusion for the first 5 days from the day before transplantation, followed by the same amount by mouth. In cases 3, 4 and 5, it was used orally to treat established GVHD every 12 hours at a daily dose of 10 mg/kg, 10 mg/kg and 5 mg/kg, respectively.
As a result, no clinical sign of GVHD was recognized in the 2 cases in whom it was used for prevention, CsA proving effective.
Although some side effects were caused by CsA, one of which was renal dysfunction (lowering of the creatinine clearance) observed in 2 out of the 5 cases, they were improved by decreasing the dose. Notable myelosuppression was also recognized in 2 cases, where medication was stopped and hematological recovery appeared promptly. This side effect as well as renal toxicity should be cautiously observed and treated.
Other side effects were hepatic toxicity, tremor and hirstism, each of which was seen in one of the cases. As a result of monitoring the trough level and peak level of CsA in serum or plasma, the correlation between the serum or plasma levels and renal toxicity was shown.
Therefore, from clinical point of view, it is desirable to design the proper dose of CsA to be given based on the serum or plasma concentration.
