Inoue Hiroaki, Morita Yasuyoshi, Rai Shinya, Kakutani Hiroaki, Ohyama Yasuyo, Taniguchi Yasuhiro, Tanaka Hirokazu, Shimada Takahiro, Tatsumi Yoichi, Ashida Takashi, Matsumura Itaru
Division of Hematology and Rheumatology, Department of Internal Medicine, Kindai University Faculty of Medicine.
Rinsho Ketsueki. 2017;58(2):138-142. doi: 10.11406/rinketsu.58.138.
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/m AZA 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.
实体器官移植后进行免疫抑制治疗是骨髓增生异常综合征（MDS）发生的已知危险因素。在此，我们报告2例患者，均在实体器官移植后发生低危MDS，并成功接受了阿扎胞苷（AZA）治疗。第1例为一名74岁接受肝移植的男性。初始免疫抑制治疗包括环孢素和泼尼松龙。移植9年后，他被诊断为患有MDS（RCMD）。第2例为一名47岁接受尸体肾移植的女性。初始免疫抑制治疗包括环孢素、硫唑嘌呤和泼尼松龙。移植27年后，她发生了MDS（RA）。两名患者均以28天为一个周期，连续5天每天接受75 mg/m²的AZA治疗。经过2个疗程的治疗，两名患者均实现了血液学改善（按照2006年国际工作组标准），且未出现严重（3/4级）非血液学不良事件。此外，就移植物的植入和功能而言，AZA并未影响器官移植状态。总之，对于实体器官移植后发生MDS的患者，AZA将是一种安全有效的药物。然而，需要长期随访以确认AZA对接受实体器官移植患者的安全性和有效性。
