title: Fatal leukoencephalopathy after reduced-intensity allogeneic stem cell transplantation.
abstract: BACKGROUND
  Toxicity associated with immunosuppression and conditioning regimens represents a common cause of neurological complications after allogeneic stem cell transplantation.
  
  
  METHODS
  We present a 56-year-old female patient with refractory acute lymphoblastic leukemia undergoing reduced-intensity conditioning with fludarabine, BCNU and melphalan followed by matched-sibling allogeneic stem cell transplantation. Under immunosuppressive treatment with cyclosporine A (CSA) the patient developed early-onset (day +33) and ultimately fatal leukoencephalopathy.
  
  
  CONCLUSIONS
  As fludarabine and CSA represent two key substances of today's reduced-intensity conditioning regimens we raise the question of whether CSA, fludarabine or a combination of both led to this outcome and discuss differential diagnoses.
authors.affiliation: Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg i. Br., Germany. mielkes@nhlbi.nih.gov
authors.forename: Stephan
authors.initials: S
authors.lastname: Mielke
authors.forename: Karin
authors.initials: K
authors.lastname: Potthoff
authors.forename: Friedrich
authors.initials: F
authors.lastname: Feuerhake
authors.forename: Thorsten A
authors.initials: TA
authors.lastname: Bley
authors.forename: Marisa
authors.initials: M
authors.lastname: Windfuhr
authors.forename: Hartmut
authors.initials: H
authors.lastname: Bertz
authors.forename: Jürgen
authors.initials: J
authors.lastname: Finke
mesh_terms: D000970:Antineoplastic Agents; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects*; D003711:Demyelinating Diseases / Q000139:chemically induced* / Q000175:diagnosis; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D018570:Risk Assessment; D033581:Stem Cell Transplantation; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan; D002330:Carmustine