title: [Acute lymphoblastic leukemia presenting with calcineurin-inhibitor induced pain syndrome after a second allogeneic bone marrow transplantation].
abstract: A 42-year-old woman was referred to us for the treatment of relapsed Philadelphia-positive acute lymphoblastic leukemia (Ph+ALL), which had been maintained in complete remission for seven years after an allogeneic bone marrow transplantation (allo-BMT) from an unrelated donor. She received remission-reinduction chemotherapy combined with imatinib mesylate. After the documentation of the molecular remission of Ph+ALL, she underwent the second allo-BMT from another unrelated donor. GVHD prophylaxis consisted of tacrolimus (TAC) and short-term methotrexate. On day 21, she suddenly suffered from an intermittent severe, cramp-like pain in the right lower limb. The typical pain profile and exclusion of other causative diseases suggested calcineurin-inhibitor induced pain syndrome (CIPS) as a possible cause of pain. The pain was gradually relieved after discontinuation of TAC and administration of several analgesic drugs. CIPS is rarely seen following allogeneic stem cell transplantation (allo-SCT); only three cases have been so far reported to our knowledge. Thus, physicians should be alert to this complication in patients receiving allo-SCT.
authors.affiliation: Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takashima
authors.forename: Akihiko
authors.initials: A
authors.lastname: Numata
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shirakawa
authors.forename: Rieko
authors.initials: R
authors.lastname: Kinoshita
authors.forename: Kouji
authors.initials: K
authors.lastname: Kato
authors.forename: Katsuto
authors.initials: K
authors.lastname: Takenaka
authors.forename: Naoki
authors.initials: N
authors.lastname: Harada
authors.forename: Koji
authors.initials: K
authors.lastname: Nagafuji
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Mine
authors.initials: M
authors.lastname: Harada
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation; D019703:Calcineurin / Q000009:adverse effects*; D065095:Calcineurin Inhibitors; D020918:Complex Regional Pain Syndromes / Q000139:chemically induced*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D019172:Transplantation Conditioning
chemical_list: D065095:Calcineurin Inhibitors; D019703:Calcineurin