Transplant Channel

Transplant Med Side Effect Matching Quiz (2)
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Explanations:
Cytokine release syndrome with OKT3
Administration of muromonab-CD3 is frequently associated with a Cytokine release syndrome starting within 1 to 3 hours after the first dose and lasting for approximately 12 to 16 hours. Many symptoms (similar to anaphylaxis) may be observed, including pyrexia, chills, dyspnea, chest pain and tightness, wheezing, nausea, vomiting, and diarrhea. The severity may range from mild flu-like symptoms to severe and life threatening shock-like reactions. Pulmonary edema is the most serious consequence of this reaction, occurring most commonly in the presence of hypervolemia. Nephrotoxicity, meningitis and encephalopathy may also occur.

Although this reaction occurs most frequently after the initial dose of muromonab-CD3, it may be observed after the second dose to a lesser extent, but subsequent doses appear to be well tolerated. However, these effects may be seen following a treatment hiatus and resumption of therapy (Prod Info Orthoclone OKT3(R), 2000; Gaston et al, 1991; Todd & Brogden, 1989; Thistlethwaite et al, 1988; First et al, 1992; First et al, 1993; Radhakrishnan & Cohen, 1993; Kreis, 1993).

Diarrhea with mycophenolate mofetil
Diarrhea has been reported in 31% to 36% of renal transplant patients in clinical studies of mycophenolate; CONSTIPATION has occurred in approximately 18% to 23% and NAUSEA occurred in approximately 19% to 24% of patients. After cardiac transplantation, the following adverse effects were reported: nausea (54%), diarrhea (45.3%), constipation (41.2%), abdominal pain (33.9%) and vomiting (33.9%); incidences were similar in liver transplant patients.

Nausea and DIARRHEA, usually occur early in therapy and respond to dose reduction or switching from two to three divided daily doses. The adverse effect profile was similar after oral or intravenous administration of mycophenolate mofetil (Prod Info CellCept(R), 2000; Ensley et al, 1993; Sollinger et al, 1992a; Sollinger et al, 1992; Deierhoi et al, 1993; Goldblum, 1993).

Tacrolimus and hypomagenesemia
See Perez-Ruiz et al.

Cysclosporine and bone pain
See Grotz et al.

Bacterial and viral infections with alemtuzumab
Serious, sometimes fatal, opportunistic infections (bacterial, viral and fungal) have been reported with alemtuzumab therapy. In a clinical study involving 93 patients receiving alemtuzumab as a single therapy for chronic lymphocytic leukemia, 43% of patients had at least 1 infection; 37% of the infections were considered grade 3 or 4 severity (not defined) and 18% were fatal. FEBRILE NEUTROPENIA (ANC less than 500 cells/liter) occurred in 10% of patients. All patients received anti-herpes and anti-Pneumocystis prophylaxis while receiving alemtuzumab therapy and were followed for 6 months. In clinical trials that did not require anti-infective prophylaxis, 66% of patients experienced at least 1 infection (Prod Info Campath(R), 2001