Reversal of recalcitrant cardiac allograft rejection with XXXX .

@entity500 @entity55 @entity229 @entity205 @entity358 @entity1500 @entity1431 @entity299 @entity1499 @entity792
Refractory @entity299 is a major therapeutic dilemma. The effectiveness of @entity1499 ( @entity1500 ) in @entity792 prompted us to explore its efficacy in 10 cardiac transplant recipients, aged 20-53 years (39 +/- 13 years; mean +/- SD), with biopsy evidence of drug-refractory cardiac allograft rejection. Nine cardiac transplant recipients were maintained on triple antirejection therapy ( @entity205 , @entity500 , and @entity229 ), and the remaining recipient was maintained on @entity205 and @entity229 . Rejection episodes treated with @entity1500 occurred 20-422 days (165 +/- 137 days) after transplantation and were the sixth episode of rejection for one recipient, the third for four recipients, the second for four recipients, and the first for one recipient. Before @entity1500 administration, cardiac allograft rejection persisted despite intensified immunosuppression including OKT3 antibody. @entity1500 , given intravenously, orally, or by both routes at a dose of 10-175 mg (85 +/- 62 mg), reversed rejection in nine of 10 recipients (90%) within 7-63 days (26 +/- 18 days). @entity358 wedge pressures were reduced to normal levels after @entity1500 therapy (15.2 +/- 3.5 before vs. 10.6 +/- 3.0 mm Hg after; p less than 0.05). @entity1431 occurred in five cardiac transplant recipients after treatment with @entity1500 . Adverse reactions to @entity1500 resolved after @entity1500 therapy was discontinued in all but one recipient. This recipient received one of the larger @entity1500 doses (150 mg) and developed @entity55 . Twelve moderate rejection episodes recurred in nine recipients, seven episodes of which were successfully re-treated with @entity1500 . Two of these seven recipients have now been rejection-free for 15 months. Of five recurrent episodes of @entity299 not treated with @entity1500 , two could not be reversed and were fatal. @entity1500 may be a valuable drug for reversing refractory cardiac allograft rejection. Before @entity1500 therapy gains wider use, however, a clearer understanding of its enhanced ability to suppress the bone marrow is needed.
