Document Detail


A syndrome of irreversible leukoencephalopathy following pediatric allogeneic bone marrow transplantation.
MedLine Citation:
PMID:  16365853     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite decreases in overall mortality following bone marrow transplantation (BMT), a number of complications such as neurotoxicity have been described and often associated with immunosuppressive agents. The syndrome of reversible posterior leukoencephalopathy has been described in patients receiving cyclosporin and FK-506. We report here a subset of children who developed a syndrome of previously undescribed irreversible leukoencephalopathy following allogeneic BMT. PATIENTS AND METHODS: Between 1996 and 2002, 138 pediatric patients received an allogeneic BMT at Lucile Salter Packard Children's Hospital at Stanford. Six cases of irreversible leukoencephalopathy were observed. Cases were defined as children who exhibited progressive and continued, severe neurologic deterioration lasting greater than 2 weeks and consistent with non-localizing, central nervous system abnormalities. Medical records and magnetic resonance images (MRIs) were reviewed. RESULTS: Median age of the affected patients at BMT was 7.8 years. All six received cyclosporine, and [corrected] one had elevated drug levels. Encephalopathy occurred at a median of 53 days (range 14-77) following BMT. Symptoms at onset of leukoenceophalopathy included confusion and altered mental status, sluggish pupillary responses, abnormal movements, and seizures. Two patients died during their neurologic decline. Four patients remain alive with persistent encephalopathy. MRI showed abnormalities in all patients including periventricular or subcortical white matter involvement in all, and basal ganglia lesions in three. CONCLUSIONS: We report a syndrome of irreversible neurologic deficits and cerebral white matter abnormalities following allogeneic BMT, yet not associated with elevated cyclosporin levels. A precise mechanism for this syndrome is lacking and warrants further consideration.
Authors:
A Yuriko Minn; Paul G Fisher; Patrick D Barnes; Gary V Dahl
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric blood & cancer     Volume:  48     ISSN:  1545-5009     ISO Abbreviation:  Pediatr Blood Cancer     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2006-12-12     Completed Date:  2007-02-01     Revised Date:  2009-01-12    
Medline Journal Info:
Nlm Unique ID:  101186624     Medline TA:  Pediatr Blood Cancer     Country:  United States    
Other Details:
Languages:  eng     Pagination:  213-7     Citation Subset:  IM    
Affiliation:
School of Medicine, Stanford University, Palo Alto, California 94305, USA.
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MeSH Terms
Descriptor/Qualifier:
Bone Marrow Transplantation / adverse effects*
Brain Diseases / etiology*
Child
Child, Preschool
Cyclosporine / therapeutic use
Female
Humans
Magnetic Resonance Imaging
Male
Syndrome
Transplantation, Homologous
Chemical
Reg. No./Substance:
59865-13-3/Cyclosporine
Comments/Corrections
Comment In:
Pediatr Blood Cancer. 2008 Feb;50(2):426; author reply 427   [PMID:  17427233 ]
Erratum In:
Pediatr Blood Cancer. 2007 Mar;48(3):372

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


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