Antithymocyte globulin
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Antithymocyte globulin Hepatotoxicity: case report A 23-year-old woman with Fanconi’s anaemia developed hepatotoxicity during conditioning treatment with horse antithymocyte globulin (ATG) prior to haematopoietic stem cell transplantation (HSCT); she was then successfully treated with rabbit ATG. According to the conditioning regimen, the woman was premedicated and received her first dose of IV horse ATG 40 mg/m2 on day -6 HSCT, infused over 10 hours; her concomitant medication included cyclophosphamide, ciclosporin, aciclovir, fluconazole and cotrimoxazole [trimethoprim/sulfamethoxazole]. The next day, her liver values became severely elevated: her total bilirubin level was 37 µmol/L, her ALT level was 604 U/L, her AST level was 708 U/L and her lactate dehydrogenase level was 1424 U/L. Horse ATG was stopped, and cyclophosphamide and fluconazole were held. On day -4 HSCT, her liver values decreased by about 50%. Horse ATG treatment was replaced with 10-hour infusions of IV rabbit ATG using the following schedule: 10 mg/m2 on days -4, -3 and -2 HSCT, and 7 mg/m2 following transplantation (every 2 days from day +2 to +12 HSCT). Her hepatic profile continued to improve and, on day -1, cyclophosphamide was administered. She underwent HSCT the following day and fluconazole prophylaxis was resumed. Engraftment was successful, her IV medication was discontinued and she was discharged on day +28 HSCT. She later developed chronic graft-versus-host disease of the liver, requiring treatment for 8 months. On last follow-up, her liver function tests were normal. Al-Anazi KA, et al. Hepatotoxicity induced by horse ATG and reversed by rabitt ATG: a case report. Journal of Medical Case Reports 1: Online first [19 pages], No. 35, 28 Jun 2007. Available from: URL: http://www.jmedicalcasereports.com 801052198 Saudi Arabia
0114-9954/10/1162-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 28 Jul 2007 No. 1162
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