Ogawa Y, Okamoto S, Kuwana M, Mori T, Watanabe R, Nakajima T, Yamada M, Mashima Y, Tsubota K, Oguchi Y
Department of Ophthalmology, Division of Hematology, the Department of Medicine, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan.
Cornea. 2001 May;20(4):430-4. doi: 10.1097/00003226-200105000-00020.
We present two cases of severe dry eye in patients with chronic graft-versus-host disease (CGVHD) after hematopoietic stem cell transplantation (SCT) who were successfully treated by the systemic administration of FK506 and corticosteroids.
A 29-year-old man with chronic myelogenous leukemia underwent SCT. Oral and lung CGVHD developed on approximately day 130, and dry eye associated with CGVHD was diagnosed on day 168. The patient began receiving cyclosporin A (150 mg/d) for the treatment of oral and lung CGVHD. Treatment with prednisolone (1 mg/kg/d) began on approximately day 300. Oral and lung GVHD improved slightly, but worsened again although systemic administration of cyclosporin A and prednisolone were continued. Cyclosporin A was discontinued, and systemic administration of FK506 was started on day 376. Forty-four days later, marked improvement in the ocular surface and other organs was observed. However, the dry eye worsened while tapering FK506, with no flare of other affected organs. A 43-year-old woman with myelodysplastic syndrome underwent SCT. She received FK506 for prophylaxis of CGVHD. She had mild dry eye before SCT. Oral and intestinal CGVHD developed, and the dry eye worsened significantly on approximately day 150 while tapering FK506. Treatment with prednisolone (1 mg/kg/d) began, and the dose of FK506 was increased. By day 240, the symptoms of dry eye and the findings of the ocular surface markedly improved, and CGVHD in other organs was completely resolved. However, the improvement in the dry eye was lost when FK506 was tapered for the second time.
Systemic administration of FK506 with corticosteroids is an effective treatment of severe dry eye in patients with CGVHD, but long-term administration may be required to achieve a lasting response. These cases also suggest that further investigation into the use of topical FK506 and prednisolone as a maintenance therapy should be pursued.
我们报告两例造血干细胞移植（SCT）后患有慢性移植物抗宿主病（CGVHD）的严重干眼症患者，通过全身性给予FK506和皮质类固醇成功治愈。
一名29岁的慢性粒细胞白血病男性接受了SCT。大约在第130天出现口腔和肺部CGVHD，并在第168天诊断出与CGVHD相关的干眼症。患者开始接受环孢素A（150毫克/天）治疗口腔和肺部CGVHD。大约在第300天开始使用泼尼松龙（1毫克/千克/天）治疗。口腔和肺部GVHD略有改善，但尽管继续全身性给予环孢素A和泼尼松龙，病情再次恶化。环孢素A停药，并在第376天开始全身性给予FK506。44天后，观察到眼表和其他器官有明显改善。然而，在逐渐减少FK506用量时干眼症恶化，其他受累器官无复发。一名43岁的骨髓增生异常综合征女性接受了SCT。她接受FK506预防CGVHD。SCT前她有轻度干眼症。出现口腔和肠道CGVHD，在大约第150天逐渐减少FK506用量时干眼症明显恶化。开始使用泼尼松龙（1毫克/千克/天）治疗，并增加FK506剂量。到第240天，干眼症症状和眼表表现明显改善，其他器官的CGVHD完全缓解。然而，第二次逐渐减少FK506用量时干眼症的改善消失。
全身性给予FK506联合皮质类固醇是治疗CGVHD患者严重干眼症的有效方法，但可能需要长期给药才能获得持久反应。这些病例还表明，应进一步研究局部使用FK506和泼尼松龙作为维持治疗的方法。
