Treatment of posttransplantation diabetes mellitus with anti-CD20 monoclonal antibodies
Notice bibliographique
Résumé
Anti-CD20 has been successfully used for the treatment of immune manifestations after HSCT. We report the use of this treatment for post-HSCT diabetes mellitus. An 11-year-old boy received a HSCT from an HLA-identical sibling for AML CR1. Preparative regimen consisted of fractioned TBI and etoposide, along with graft-versus-host prophylaxis of cyclosporin and methotrexate. SCT resulted in full donor engraftment. Cyclosporin was discontinued on day 28 posttransplantation due to renal failure. Subsequently, acute grade III skin GVHD was successfully treated with glucocorticoids, with no glucose intolerance. Glucocorticoids were discontinued at 5 months posttransplantation. At that time, buccal lichen planus was present. No specific treatment was given. At 12 months posttransplantation, the patient developed bronchiolitis obliterans and vitiligo (face, arms, and hips). Prednisone (up to 1 mg/kg/day) was resumed; pulmonary function improved, but skin lesions persisted unchanged. Again, glucocorticoid therapy did not induce glucose intolerance. At 22 months posttransplantation, glucocorticoids were tapered and azathioprine and hydroxychloroquine begun. Mofetylmycofenolate was substituted for azathioprine at 28 months posttransplantation. At 31 months posttransplantation, the patient discontinued all treatment, including glucocorticoids. His condition remained stable thereafter until he developed hypothyroidism at 69 months posttransplantation, treated with L-thyroxine. Antimicrosomal and antithyroglobulin antibodies were negative. At 81 months posstransplantation, the patient experienced polyuria, polydipsia, and major weight loss. Hos blood sugar level was 36 mmol/l (648 mg/dl). He had ketonuria but no ketoacidosis. His HbA1c level was 13.4% (normal, 4.8% to 6.0%). The diagnosis of diabetes mellitus was made. Diabetes was controlled with insulin, 1.1 U/kg/day. Tests for associated autoantibodies were all negative, including anti–glutamic acid decarboxylase (GAD) antibodies. There was no history of diabetes mellitus in the donor or in the more extended family. The patient’s body mass index was in the 72nd percentile. Four doses of weekly intravenous (IV) rituximab(375 mg/m2/dose) were administered, followed by monthly IV gammaglobulins. Insulin was discontinued 3 months after the last dose of rituximab therapy. Four months later, the patient remains free of symptoms and normoglycemic, with an HbA1c level of 6,1%. Although the patient may be experiencing a “honeymoon” phenomenon with spontaneous, transitory remission of diabetes, our experience could also suggest that diabetes mellitus developing after SCT may be of immune origin, and that early treatment with anti-CD20 might modify the course of the disease.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».