title: Bone marrow suppression and associated consequences in patients after heart transplantation: A 6-year retrospective review.
abstract: OBJECTIVE
  To evaluate the incidence of bone marrow suppression and consequences of MMF dose adjustment in patients within the first year after heart transplantation.
  
  
  METHODS
  Group I (n=47) was treated with a regimen currently used in patients after heart transplantation (mycophenolatemofetil - MMF, valganciclovir - VGC and trimethoprim/sulfamethoxazole - TMP-SMX). Group II (n=47) received only MMF of potentially myelotoxic medications. The myelotoxic effect and need for dose modification were assessed. The incidence of rejections and infectious episodes associated with MMF adjustment were analyzed during the first 12 months in Group I.
  
  
  RESULTS
  There was a significantly greater proportion of patients with leukopenia (leukocyte count < 4 x 10^9/L) at 3 months after orthotopic heart transplantation in Group I compared with Group II (19.1% vs 2.1%; P = 0.02). The difference in lymphopenia (lymphocyte count < 0.8 x 10^9/L) at 3 months follow-up was highly significant (38.3 % vs 6.4 %; P = 0.0002). MMF was modified due to bone marrow suppression or severe infection in 63.8% patients in Group I and in only 8.5% of patients in Group II (P < 0.001). Reducing or stopping MMF was not associated with increased rejections. In Group I, at least 1 episode of higher degree cellular or humoral rejection occurred in 35% of patients with the standard MMF dosage compared with only 26% in patients with modified MMF (P = 0.0534).
  
  
  CONCLUSIONS
  Addition of VGC+TMP-SMX to current immunosuppressive medication regimen in patients after heart transplantation is associated with significant lymphocytopenia and leukopenia. Importantly, modification of immunosuppressive prophylaxis (reducing or stopping MMF) leads to normalization of blood count without increased incidence of rejections.
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Pazdernik
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
authors.forename: Ivan
authors.initials: I
authors.lastname: Malek
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Koudelkova
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Sochman
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
mesh_terms: D001853:Bone Marrow / Q000187:drug effects* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy* / Q000473:pathology; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: heart transplant; medication regimen; myelotoxicity; rejections