title: [A clinical analysis of severe cyclosporine A-related neurotoxicity after allogenic hematopoietic stem cell transplantation].
abstract: OBJECTIVE
  To investigate the morbidity, clinical manifestations, and imageology characteristics, and the influencing factors of severe cyclosporine A (CsA)-related neurotoxicity (SNCT) in the patients after allogenic hematopoietic stem cell transplantation (allo-HSCT).
  
  
  METHODS
  Finding of SNCT was carried out in 164 allo-HSCT recipients from January 2003 to June 2006. Clinical characteristics were analysed, including precursory symptoms and clinical manifestations. Associations between the onset of SNCT with blood CsA levels, age, transplant types, human leucocyte antigen (HLA) matching, conditioning regimens, antihuman thymocyte globulin (ATG) used in the prevention and treatment for graft-versus-host disease (GVHD) and intravenous corticosteroid used for acute GVHD were analyzed. Statistical analysis was performed with Binary Logistic Regression using SPSS/PC version 11.0.
  
  
  RESULTS
  Thirteen patients (7.93%) were identified to have SNCT, including seizures (n = 8, 4.88%), paralysis (n = 6, 3.66%), coma (n = 2, 1.22%), cerebellar ataxia (n = 3, 1.83%) and chondroid encephalomyopathy (n = 1, 0.61%). All the patients had precursory symptoms prior SNCT including headache (n = 8), agitation (n = 4) and hypertension (n = 6). Magnetic resonance imaging (MRI) performed in twelve patients after SNCT showed that eleven patients had signal abnormalities in cerebral cortex and cerebral white matter. Six patients examined with computerized tomography (CT) had no abnormal findings. After extenuation or withdrawal of CsA, ten patients had complete recovery, two had partial recovery and one died of SNCT. Simple effect analysis of Binary Logistic Regression showed that the associations between the onset of SNCT with blood CsA levels, transplant types, HLA matching, ATG used in the prevention and treatment for GVHD and intravenous corticosteroid used for acute GVHD were of statistical significance. The multiple effect analysis of Binary Logistic Regression showed that the associations of the onset of SNCT with blood CsA levels and ATG used had statistical significance and the odds ratio (OR) was 1.007 (P = 0.006) and 6.727 (P = 0.030), respectively.
  
  
  CONCLUSIONS
  91.67% of the allo-HSCT recipients with SNCT have MRI abnormalities. High blood CsA levels and the use of ATG can elevate the risk of the occurrence of SNCT.
authors.affiliation: Department of Hematology, Nanfang Hospital, Nanfang Medical University, Guangzhou 510515, China.
authors.forename: Xiao-Dan
authors.initials: XD
authors.lastname: Luo
authors.forename: Qi-Fa
authors.initials: QF
authors.lastname: Liu
authors.forename: Juan
authors.initials: J
authors.lastname: Ning
authors.forename: Zhi-Ping
authors.initials: ZP
authors.lastname: Fan
authors.forename: Dan
authors.initials: D
authors.lastname: Xu
authors.forename: Yong-Qiang
authors.initials: YQ
authors.lastname: Wei
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007938:Leukemia / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000209:etiology*; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine