[Leukoencephalopathy probably caused by tacrolimus hydrate after stem cell transplantation in a girl with MDS 7 monosomy].
Leukoencephalopathy probably caused by tacrolimus hydrate after stem cell transplantation in a girl with MDS 7 monosomy is reported. The conditioning regimen consisted of thiotepa (150 mg/m2 x 4), melphalan (70 mg/m2 x 2) and 12 Gy total body irradiation. She received peripheral blood CD34 positive cells (4.17 x 10(6)/kg) from her HLA-mismatched father and tacrolimus hydrate was used for GVHD prophylaxis. Engraftment was rapid and grade 1 acute GVHD of the skin responded well to pulse therapy. From day 27 she became irritable and sleepless, and right facial convulsions developed on day 37. No abnormality was found in the cerebrospinal fluid. Cranial CT findings showed no abnormalities except for low density lesions around the bilateral ventricle. Leukoencephalopathy was suspected and tacrolimus hydrate was discontinued. Thereafter psychosomatic symptoms improved, temporarily however, similar symptoms again developed following cyclosporine administration. Therefore we had to halt the administration of both tacrolimus and cyclosporine. She died on day 104 because of GVHD and fungal infection without recovering from leukoencephalopathy.
Yoshimoto
T
T
Department of Pediatrics, Osaka Medical Center.
Yagi
K
K
Inoue
M
M
Okamura
T
T
Yasui
M
M
Cyayama
K
K
Nakano
T
T
Tsuchiya
H
H
Kawa
K
K
D001927:Brain Diseases / Q000139:chemically induced*; D002675:Child, Preschool; D002897:Chromosomes, Human, Pair 7; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D009006:Monosomy; D009190:Myelodysplastic Syndromes / Q000235:genetics / Q000628:therapy*; D016559:Tacrolimus / Q000009:adverse effects*
D007166:Immunosuppressive Agents; D016559:Tacrolimus