title: Myasthenia gravis after allogeneic bone marrow transplantation treated with mycophenolate mofetil monitored by peripheral blood OX40+ CD4+ T cells.
abstract: A patient who developed myasthenia gravis (MG) 25 months after allogeneic bone marrow transplant was immunologically analyzed. OX40+CD4+ T cells in the peripheral blood prominently increased one month before the onset of MG. CD4/CD8 ratios, usually abnormally inverted in patients with chronic graft-vs.-host disease (cGVHD), showed pseudonormalization during the course of MG. We succeeded in uneventful rapid tapering of prednisolone (PSL) using mycophenolate mofetil (MMF). Monitoring of OX40+CD4+ T cells supported the tapering of PSL and MMF as a marker of cGVHD activity. This case suggested the utility of MMF and monitoring of OX40+CD4+ T cells in the management of cGVHD-associated autoimmune diseases.
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Kotani
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Hikari
authors.initials: H
authors.lastname: Koga
authors.forename: Rinpei
authors.initials: R
authors.lastname: Morita
authors.forename: Hidenao
authors.initials: H
authors.lastname: Fukuyama
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Ichinohe
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Hori
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D009173:Mycophenolic Acid / Q000008:administration & dosage* / Q000031:analogs & derivatives; D053262:Receptors, OX40; D018124:Receptors, Tumor Necrosis Factor; D014184:Transplantation, Homologous / Q000009:adverse effects; D018127:Tumor Necrosis Factor Receptor Superfamily, Member 7 / Q000032:analysis*
chemical_list: D015415:Biomarkers; D053262:Receptors, OX40; D018124:Receptors, Tumor Necrosis Factor; C505716:TNFRSF4 protein, human; D018127:Tumor Necrosis Factor Receptor Superfamily, Member 7; D009173:Mycophenolic Acid