Type: Calcineurin inhibitor immunosuppressant
Mechanism of Action:
Cyclosporine binds to cyclophilin and inhibits calcineurin, preventing activation of NFAT (nuclear factor of activated T-cells). This blocks IL-2 transcription, leading to suppressed T-cell activation and proliferation.
Key Role in MDS:
- Combined with ATG in immunosuppressive therapy (IST) for selected low-risk MDS patients
- Maintains long-term immunosuppression to allow hematopoietic recovery
- Initiated with ATG and continued for ≥6 months if tolerated
Dosing Considerations:
- Oral dose: ~3–6 mg/kg/day
- Trough levels: Maintain between 150–250 ng/mL
- Requires dose adjustment in renal impairment
Adverse Effects:
Nephrotoxicity, Hypertension, Tremors, neurotoxicity, Electrolyte disturbances (↑K⁺, ↓Mg²⁺), Gingival hyperplasia, Increased risk of infections