Myasthenia gravis after allogeneic bone marrow transplantation treated with mycophenolate mofetil monitored by peripheral blood OX40+ CD4+ T cells

Eur J Haematol. 2002 Nov-Dec;69(5-6):318-20. doi: 10.1034/j.1600-0609.2002.02789.x.

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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Biomarkers / analysis
  • Bone Marrow Transplantation / adverse effects*
  • CD4-Positive T-Lymphocytes / immunology
  • Female
  • Graft vs Host Disease / diagnosis
  • Graft vs Host Disease / drug therapy
  • Humans
  • Myasthenia Gravis / diagnosis
  • Myasthenia Gravis / drug therapy*
  • Myasthenia Gravis / etiology*
  • Mycophenolic Acid / administration & dosage*
  • Mycophenolic Acid / analogs & derivatives
  • Receptors, OX40
  • Receptors, Tumor Necrosis Factor*
  • Transplantation, Homologous / adverse effects
  • Tumor Necrosis Factor Receptor Superfamily, Member 7 / analysis*

Substances

  • Biomarkers
  • Receptors, OX40
  • Receptors, Tumor Necrosis Factor
  • TNFRSF4 protein, human
  • Tumor Necrosis Factor Receptor Superfamily, Member 7
  • Mycophenolic Acid