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A Case of Acute Leukemia Remitted by Adding Cyclosporin-A Previously Failed with Induction Therapy

Journal of the Korean Pediatric Society 2000;43(7):988-992.
Published online July 15, 2000.
A Case of Acute Leukemia Remitted by Adding Cyclosporin-A Previously Failed with Induction Therapy
Seat Byeoul Park, Byung Kyu Choe, Heung Sik Kim, Chin Moo Kang
Department of P ediatrics, College of M edicine, Keimyang University, Taegu, Korea.
관해유도요법에 실패 후 Cyclosporin-A 첨가로 완전관해가 유도된 백혈병 1례
박샛별, 최병규, 김흥식, 강진무
계명대학교 의과대학 소아과학교실
Clinical chemotherapy refractoriness is characterized by resistance to multiple drugs. Multidrug resistance(MDR) is caused by over-reactivity of a unidirectional drug efflux pump, transmembrane glycoprotein(P-glycoprotein), which is encoded by the MDR1 gene. P-glycoprotein leads to increased drug efflux and decreased intracellular drug concentration. Clinical trials that attempt to reverse or modulate MDR have been done. Cyclosporin-A and verapamil are the most extensively studied agents and several trials of cyclosporin-A as a MDR modulator have been reported. We report a case of an 8-year-old girl with acute mixed type leukemia who failed to respond 3 times to remission-induction therapy. It led us to conclude she had multidrug resistance. We tried a fourth induction chemotherapy including cytarabine, idarubicin and 6-thioguanine to which cyclosporin- A was added. Then, she showed signs of severe bone marrow depression and fulminant perianal cellulitis. But she recovered and successfully achieved complete remission. The addition of cyclosporine could be useful in achieving complete remission for cases of acute leukemia that resist to usual chemotherapy. Futher observation including more cases will be needed to assess long-term survival and efficacy of adding cyclosporine.
Key Words: Drug resistance, Cyclosporin-A, Leukemia

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