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Bone marrow hypoplasia complicating tacrolimus (FK506) therapy

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Abstract

Tacrolimus (FK506)-induced hematological toxicity, which has rarely been reported in transplant recipients, may result in anemia episodes, reported mainly in kidney and heart transplant recipients, sporadic cases of thrombotic thrombocy-topenic purpura/hemolytic uremic syndrome, red cell aplasia (4 reported cases), and generalized bone marrow suppression (only 1 reported case). We describe a case of a liver transplant recipient with pancytopenia that appeared during immunosuppressive therapy with tacrolimus. This patient suffered from progressive anemia, leukopenia with severe neu-tropenia, and mild thrombocytopenia; bone marrow biopsy showed hypoplasia (20% of cellularity) without dysplasia. Bone marrow recovery was made possible by suspending tacrolimus and changing to immunosuppression with cyclo-sporine A, despite the two drugs being very similar in their mechanism of immunosuppression. Contrary to previously reported cases (pure red cell aplasia and bone marrow hypoplasia), the recovery of hemoglobin and neutrophil values was slow after tacrolimus suspension, even though in the first month transfusions were no longer necessary.

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Authors and Affiliations

  1. Department of Oncology and Haematology, Niguarda Ca’ Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milano, Italy

    Annamaria Nosari, Laura Marbello, Giuliana Muti, Valentina Mancini & Enrica Morra

  2. Haematology Unit and Liver Transplant Unit, Niguarda Ca’ Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milano, Italy

    Luciano G. De Carlis & Andrea De Gasperi

Authors
  1. Annamaria Nosari
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  2. Laura Marbello
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  3. Luciano G. De Carlis
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  4. Andrea De Gasperi
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  5. Giuliana Muti
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  6. Valentina Mancini
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  7. Enrica Morra
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Correspondence to Annamaria Nosari.

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Nosari, A., Marbello, L., De Carlis, L.G. et al. Bone marrow hypoplasia complicating tacrolimus (FK506) therapy. Int J Hematol 79, 130–132 (2004). https://doi.org/10.1532/IJH97.E0213

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  • DOI: https://doi.org/10.1532/IJH97.E0213

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