tacrolimus and Leukemia--Erythroblastic--Acute

A 57-year-old male patient in the first remission of acute erythroid leukemia underwent reduced-intensity umbilical cord blood transplantation. He developed grade III acute graft-versus-host disease (GVHD) on day 29. Although the acute GVHD was resolved with tacrolimus and steroid therapy, weakness developed in the left upper extremity on day 59. Neurological examination demonstrated asymmetric muscular weakness of the extremities with the proximal part of the left upper extremity being markedly affected. Neurophysiological studies suggested that this was due to immune-mediated demyelinating neuropathy. Intravenous immunoglobulin (IVIG) therapy was administered at a dose of 0.4 g/kg/day for 5 days and worsening of clinical symptoms ceased. While the patient developed diarrhea and chronic GVHD of the skin and cytomegalovirus (CMV) antigenemia was repeatedly positive, neurological exacerbation was stabilized. Neurological symptoms did not immediately improve after the second and third dose of IVIG. Approximately 50 days after the third dose of IVIG, neurological symptoms improved with the gradual resolution of diarrhea and CMV reactivation. Although the pathophysiology of polyneuropathies after allo-SCT is not well understood, some reports suggest an association with GVHD or alloreactive T cell expansion following antecedent infection. This case provides valuable information regarding the pathophysiology of peripheral neuropathy following allo-SCT.

Topics: Acute Disease; Cord Blood Stem Cell Transplantation; Graft vs Host Disease; Humans; Immunoglobulins, Intravenous; Leukemia, Erythroblastic, Acute; Male; Middle Aged; Peripheral Nervous System Diseases; T-Lymphocytes; Tacrolimus; Transplantation Conditioning

We performed an HLA-mismatched T cell non-depleted bone marrow transplant on a 53-year-old man with acute erythroleukemia that was highly resistant to conventional remission-induction chemotherapy. After conditioning that included total body irradiation, the patient received a two-HLA-antigen-mismatched bone marrow graft harvested from his sister using tacrolimus and methotrexate for graft-versus-host disease (GVHD) prophylaxis. He successfully established rapid engraftment accompanied by steroid-responsive GVHD localized to the skin. Although bone marrow samples on day 31 and day 66 disclosed a complete remission with full donor chimerism, the patient relapsed and died of pulmonary infection on day 154. There is evidence that tacrolimus is effective in alleviating GVHD. Selected patients who have partially mismatched related donors with less HLA disparity may benefit from tacrolimus-based T cell non-depleted bone marrow transplants because of the more potent graft-versus-leukemia effect that can be expected compared to transplants using T cell depleted inoculum.

Topics: Bone Marrow Transplantation; Graft vs Host Disease; Histocompatibility Testing; Humans; Leukemia, Erythroblastic, Acute; Male; Methotrexate; Middle Aged; Remission Induction; T-Lymphocytes; Tacrolimus; Tissue Donors

The Ca2+-induced expression of the primary response genes egr-1 and c-fos was investigated in the murine erythroleukaemia cell line ELM-I-1. Exposure of the cells to the Ca2+-ionophore A23187 led to a rapid transient rise in egr-1 and c-fos mRNA production followed by an increase in Egr-1 and c-Fos protein levels as well as an increase in Egr-1 and activator protein 1 (AP-1) DNA-binding activity. Preincubation of the cells with KN-62, a specific inhibitor of Ca2+/calmodulin-dependent protein kinases, strongly decreased the Ca2+-mediated expression of egr-1 and c-fos. In contrast, treatment with cyclosporin A, which inhibits the Ca2+/calmodulin-dependent protein phosphatase 2B or calcineurin, increased both egr-1 and c-fos mRNA production and the DNA-binding activity of the Egr-1 and AP-1 transcription factors in response to the intracellular Ca+ concentration ([Ca2+]i)-increasing agents A23187 or cyclopiazonic acid. Enhancement of the Ca2+-induced c-fos and egr-1 expression by cyclosporin A was correlated with the capability of this agent to inhibit calcineurin phosphatase activity in ELM-I-1 cells. Studies on the phosphorylation state and DNA-binding activity of the cAMP response element-binding protein (CREB) did not demonstrate an early Ca2+-dependent activation of this transcription factor, suggesting that the regulation of c-fos and egr-1 expression by Ca2+ is not linked to CREB in the haematopoietic ELM-I-1 cells. The results indicate that calcineurin exerts negative regulatory effects on both egr-1 and c-fos expression in murine erythroleukaemia cells, in addition to the calcineurin-mediated down-regulation of c-myb expression observed previously in this cell system. This study therefore emphasizes the important role of calcineurin as a negative modulator of gene expression in certain cell types.

Topics: Animals; Calcimycin; Calcineurin Inhibitors; Calcium; Calcium-Calmodulin-Dependent Protein Kinases; Cyclic AMP Response Element-Binding Protein; Cyclosporine; DNA-Binding Proteins; Early Growth Response Protein 1; Gene Expression Regulation, Neoplastic; Genes, fos; Immediate-Early Proteins; Leukemia, Erythroblastic, Acute; Mice; Protein Tyrosine Phosphatases; Proto-Oncogene Proteins c-fos; RNA, Messenger; Tacrolimus; Transcription Factor AP-1; Transcription Factors; Transcription, Genetic; Tumor Cells, Cultured

Down-regulation of c-myb mRNA levels by [Ca2+]i-increasing agents (A23187, thapsigargin, cyclopiazonic acid) and erythropoietin was comparatively studied in the erythropoietin-responsive murine erythroleukemia cell line, ELM-I-1. The Ca2+-induced suppression of c-myb mRNA could be inhibited by the calmodulin antagonists trifluoperazine and calmidazolium, as well as by cyclosporin A, an inhibitor of the Ca2+/calmodulin-dependent protein phosphatase 2B (calcineurin). KN-62, an inhibitor of Ca2+/calmodulin-dependent protein kinases, did not antagonize the Ca2+-mediated decrease in c-myb mRNA. In cyclosporin A-treated ELM-I-1 cells, a close correlation could be demonstrated between the antagonization of the Ca2+ effect on c-myb mRNA levels and inhibition of the calcineurin phophatase activity. On the other hand, FK506, which did not inhibit calcineurin activity in ELM-I-1 cells, failed to prevent the Ca2+-mediated decrease in c-myb mRNA. The erythropoietin-induced down-regulation of c-myb mRNA levels could be demonstrated also in the presence of EGTA and was resistant to calmodulin antagonists and cyclosporin A. In addition, no increase in [Ca2+]i was observed in ELM-I-1 cells in response to erythropoietin. Cyclosporin A inhibited the Ca2+-induced hemoglobin production, while the erythropoietin-mediated increase in hemoglobin synthesis was not affected. The results indicate that the Ca2+-induced decrease in c-myb mRNA and increase in hemoglobin synthesis is mediated by calcineurin, while these effects of erythropoietin occur independently of Ca2+ in ELM-I-1 cells. Calcineurin may be involved in the regulation of c-myb expression in erythroid precursor cells and Ca2+ signals via calcineurin may positively modulate the differentiation inducing action of erythropoietin.

Topics: Animals; Calcineurin; Calcium; Calmodulin; Calmodulin-Binding Proteins; Cyclosporine; Down-Regulation; Enzyme Inhibitors; Erythropoietin; Gene Expression Regulation, Neoplastic; Genes, myc; Hemoglobins; Leukemia, Erythroblastic, Acute; Mice; Oncogenes; Phosphoprotein Phosphatases; Protein Kinase Inhibitors; RNA, Messenger; RNA, Neoplasm; Tacrolimus; Tumor Cells, Cultured