Treatment of acute myeloid leukaemia in a renal allograft recipient

cyclosporin may not greatly increase the toxicity ofaggressive chemotherapy used in the treatment of haematological malignancies. Sonneveld and Nooter reported a patient with resistent AML to whom they administered cyclosporin without any excessive toxicity, although their patient had profound marrow hypoplasia for three weeks.9 Septic shock is a well recognised problem in severely neutropenic patients. It is difficult to be sure that our patient's clinical course would have been any different had he not received cyclosporin. Although cyclosporin and other inhibitors of P-glycoprotein may improve the response to chemotherapy, the use of immunosuppressiVe agents during the treatment of acute myeloid leukaemia does require caution. Non-immunosuppressive cyclosporin analogues may produce the desired positive effects of P-glycoprotein inhibition without increased infection risk.'" 1 Anonymous. Multidrug resistance in cancer. [Editorial]. Lancet 1989;ii:1075-6. 2 Holmes J, Jacobs A, Carter G, et al. Multidrug-resistance in haemopoietic cell lines. Myelodysplastic Syndromes and acute myeloblastic leukaemia. Br J Haematol 1989;72: 40-4. 3 Case records ofthe Massachusetts General Hospital. Weekly clinico-pathological exercises. Case 18-1983. A young man with pancytopenia after a renal transplant. N Engi J Med 1983;308:1081-91. 4 Ellerton JA, deVeber GA, Baker MA. Erythroleukaemia in a renal transplant recipient. Cancer 1979;43:1924-6. 5 Pikler GM, Say B, Stamper S. Cytogenetic findings in acute monocytic leukaemia in a renal allograft recipient. Cancer Genet Cytogenet 1986;20:101-7. 6 Hoy WE, Packman CH, Freeman RB. Evolution of acute leukaemia in a renal allograft recipient:? Relationship to azathioprine. Transplantation 1982;33:331-3. 7 Ihle BU, Constable J, Gordon S, Mahony JF. Myelodysplasia in cadaver renal allografts: A report of four cases. Am J Kidney Dis 1985;5:251-7. 8 Butler J, Korb S, Light L. Acute myelogenous leukaemia in a renal allograft recipient receiving cyclosporine therapy. Transplantation 1990;49:813-15. 9 Sonneveld P, Nooter K. Reversal of drug-resistance by cyclosporin-A in a patient with acute myelocytic leukaemia. Br J Haematol 1990;75:208-1 1. 10 Twentyman PR, Fox NE, White DJG. Cyclosporin A and its analogues as modifiers of adriamycin and vincristine resistance in a multidrug resistant human lung cancer cell line. Br J Cancer 1987;56:55-7.