Switching from Intravenous to Oral Tacrolimus Reduces its Blood Concentration in Paediatric Cancer Patients.

BACKGROUND/AIM: Tacrolimus is an essential immunosuppressant for successful allogeneic haematopoietic stem cell transplantation (Allo-HSCT). This study aimed to examine the change in the blood concentration of tacrolimus during switching from intravenous to oral administration in allo-HSCT for paediatric cancer to predict the optimal dosage. PATIENTS AND METHODS: We retrospectively examined the medical records of 63 patients who received allo-HSCT and were administered tacrolimus. To compare bioavailability among different dose ranges, the blood concentration was divided by the dose (C/D). RESULTS: Thirty-nine patients (age range=children 1-15 years, adults 17-67 years) were switched to oral administration of tacrolimus. The C/D after switching was significantly lower in children than in adults (p=0.039). There was a strong positive correlation between age and C/D in children, whereas no correlation was observed in adults. CONCLUSION: In paediatric cancer patients, switching tacrolimus administration route may result in reduced blood concentrations. This tendency is more prominent in younger children.

Regulatory T cells in Crohn's disease following anti-TNF-α therapy.

BACKGROUND AND AIM: Anti-tumor necrosis factor alpha (TNF-α) therapy is an effective therapy for Crohn's disease (CD). We investigated FoxP3+ and CD127- regulatory T cells (Tregs) before and after administration of anti-TNF-α therapy in CD. METHODS: Eight patients with active CD who had received anti-TNF-α antibodies were enrolled. Treatment responses were followed by physical examination and Crohn's disease activity index (CDAI) scoring before and 2 weeks after the initial administration of anti-TNF-α antibodies. Peripheral blood samples were collected before and 2 weeks after treatment. White blood cell count and serum levels of C-reactive protein (CRP) and albumin were measured. FoxP3+ expression and CD127- Tregs were measured by fluorescence activated cell sorting (FACS) analysis of whole blood samples. RESULTS: Median values of CDAI decreased significantly after treatment. The proportion of FoxP3+ Tregs increased significantly after treatment. There was a significant negative correlation between ΔCD127- Tregs and Δlymphocyte. CONCLUSIONS: Anti-TNF-α therapy would enhance Tregs, which may account for the mechanism underlying the positive effect of the anti-TNF-α treatment in CD patients.