Fatal leukoencephalopathy after reduced-intensity allogeneic stem cell transplantation.
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.
Mielke
Stephan
S
Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg i. Br., Germany. mielkes@nhlbi.nih.gov
Potthoff
Karin
K
Feuerhake
Friedrich
F
Bley
Thorsten A
TA
Windfuhr
Marisa
M
Bertz
Hartmut
H
Finke
Jürgen
J
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*
D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan; D002330:Carmustine