Document Detail


Tacrolimus-related encephalopathy following allogeneic stem cell transplantation in children.
MedLine Citation:
PMID:  15814339     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Tacrolimus is a potent immunosuppressive drug widely used to prevent and treat graft-versus-host disease (GVHD) in stem cell transplantation (SCT). Among 49 patients receiving tacrolimus who underwent SCT from January 2000 to July 2003, 10 patients (20%) developed encephalopathy. The commonly observed symptoms were convulsions and drowsiness, and most patients complained of signal symptoms such as headache, nausea, and cortical blindness before onset. The most common abnormality on neuroimages was high-intensity lesions in white matter on magnetic resonance imaging T2-weighted or fluid-attenuated inversion recovery images. At onset, all patients were receiving treatment for acute GVHD (grade II/III) or extensive chronic GVHD and demonstrated an abrupt increase in blood pressure from baseline levels. The serum tacrolimus concentration was generally within acceptable levels at onset. Symptoms gradually improved in all patients when the blood pressure was lowered with antihypertensive medication, regardless of continued tacrolimus administration following a short-term suspension. The pathogenesis of tacrolimus-related encephalopathy is multifactorial, although refractory GVHD and a sudden increase in blood pressure seem to be major predisposing factors. Because the withdrawal of tacrolimus or switching to less potent anti-GVHD agents usually worsens the GVHD, the administration of tacrolimus should be managed by closely monitoring serum levels and controlling blood pressure.
Authors:
Takahisa Kanekiyo; Junichi Hara; Yoshiko Matsuda-Hashii; Hiroyuki Fujisaki; Sadao Tokimasa; Akihisa Sawada; Keiko Kubota; Kuriko Shimono; Katsumi Imai; Keiichi Ozono
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of hematology     Volume:  81     ISSN:  0925-5710     ISO Abbreviation:  Int. J. Hematol.     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-04-07     Completed Date:  2005-06-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111627     Medline TA:  Int J Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  264-8     Citation Subset:  IM    
Affiliation:
Department of Developmental Medicine, Osaka University, Graduate School of Medicine, Japan. tkhsknky@ped.med.osaka-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / administration & dosage*
Child
Child, Preschool
Female
Graft vs Host Disease / complications,  prevention & control
Hematologic Neoplasms / therapy
Hematopoietic Stem Cell Transplantation*
Humans
Immunosuppressive Agents / administration & dosage,  adverse effects*
Male
Neurotoxicity Syndromes / drug therapy*,  etiology,  physiopathology
Tacrolimus / administration & dosage,  adverse effects*
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Immunosuppressive Agents; 109581-93-3/Tacrolimus

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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