Thread: Response to ATG
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  #15  
Old Mon Feb 27, 2012, 12:20 AM
Hopeful Hopeful is offline
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Join Date: Jan 2009
Location: California, USA
Posts: 766
Hi marmab,

I can comment a little on #2. It is now thought that 5 mg/kg/day is the maximum dosage of CsA for AA patients to minimize unnecessary toxicity. I also metabolize CsA quickly. So, my expert does not even look at my troughs. (They never were at the desired level except when I was taking 12 mg/kg/day.) I've read articles that mention the problems with establishing a CsA dosage based on trough, given the differences in peoples' metabolism of the drug. It has been argued that a 2 hour reading may be more effective for people like us. Unfortunately, there haven't been any large scale studies done on this - and certainly none done on AA/MDS patients!

It looks like you are on ~8mg/kg/day of CsA, which is fairly high but not crazy-high. I was on 12 mg/kg/day of CsA and saw a rise in my counts when I decreased the dosage to the more saner 5 mg/kg/day. The rise happened about 2-3 weeks after I decreased the dosage. Maybe it was coincidence, but maybe not. I wonder if the extra stress of CsA on the kidneys negatively effects EPO/TPO production, which in turn holds down RBC and platelet counts. It may be worthwhile discussing with your doctor lowering your CsA now to 5mg/kg/day to see if it will have a positive effect.

How frequently are you getting platelet and RBC transfusions now? Have you been sick at all since the ATG? It's amazing how much a simple cold can lower your platelets when your marrow is fragile. Are your whites still low? Do you have a listing of your counts?
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55 yo female, dx 9/08, AA/hypo-MDS, subclinical PNH, ATG/CsA 12/08, partial response. small trisomy 6 clone, low-dose cyclosporine dependent
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