title: [Retrospective analysis of posterior reversible encephalopathy syndrome after allogeneic stem cell transplantation].
abstract: Posterior reversible encephalopathy syndrome (PRES) is one of the serious adverse side effects of calcineurin inhibitors, which are used for the prophylaxis of graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (allo-SCT). We retrospectively analyzed 12 patients who developed PRES after allo-SCT aiming to clarify the clinical features, risk factors, and prognosis of PRES. Median onset of PRES is 17 days after allo-SCT. The most frequent primary symptom was high blood pressure, followed by headache and visual disturbance. Nine of our patients subsequently developed systemic seizure. Sites of PRES by MRI were detected in the frontal, temporal, and parietal lobes, basal ganglia, and brain stem in addition to occipital lobe. Serum creatinine that had increased two-fold from the baseline value was identified as the only risk factor for developing PRES after allo-SCT. The incidence of acute GVHD (grade II-IV) in patients with PRES and those without were 88.9% and 48.7%; respectively (P<0.001), and most of these patients died of GVHD or GVHD-related causes. The 2-year overall survival of patients with PRES and those without were 16.7% and 72.4%, respectively (P<0.001). These data suggested the importance of early intervention for PRES and exploitation of optimal GVHD prophylaxis after developing PRES.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Keio University School of Medicine.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Aisa
authors.forename: Takehiko
authors.initials: T
authors.lastname: Mori
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Yuiko
authors.initials: Y
authors.lastname: Tsukada
authors.forename: Jyun
authors.initials: J
authors.lastname: Kato
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Suzuki
authors.forename: Norihiro
authors.initials: N
authors.lastname: Suzuki
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Okamoto
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects*; D004660:Encephalitis / Q000209:etiology*; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation; D013577:Syndrome; D016559:Tacrolimus / Q000009:adverse effects*; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine; D016559:Tacrolimus