title: Levetiracetam as a possible cause of secondary graft failure after allogenic hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Levetiracetam is increasingly used as antiepileptic drug (AED) of choice in children as well as in adults with complex diseases due to its lack of interactions and a large spectrum of action. Secondary graft failure, i.e. loss of donor cells after initial engraftment, is a relatively uncommon but serious and life-theatening complication after pediatric hematopoietic stem cell transplantation.
  
  
  RESULTS
  We report a case of secondary graft failure after hematopoietic stem cell transplantation for treatment-related myelodysplastic syndrome during antiepileptic treatment with levetiracetam. Exclusion of all other possible etiologies left levetiracetam as the most likely cause of the imminent complete secondary graft failure after hematopoietic stem cell transplantation. Furthermore, the blood cell count improved just a few days after cessation of levetiracetam medication.
  
  
  CONCLUSIONS
  Thus, we recommend that in case of secondary graft failure after hematopoietic stem cell transplantation, all possible causes should carefully be excluded, including adverse events through new generation AED agents. Switching to different AEDs with less harming effect on bone marrow function should strongly be considered.
authors.affiliation: Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Pediatrics, Medical University of Vienna, Vienna, Austria. Electronic address: andreas.peyrl@meduniwien.ac.at.
authors.forename: Andreas
authors.initials: A
authors.lastname: Peyrl
authors.affiliation: Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Weichert
authors.affiliation: Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Jörn-Sven
authors.initials: JS
authors.lastname: Kühl
authors.affiliation: Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Ebell
authors.affiliation: Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Pablo
authors.initials: P
authors.lastname: Hernáiz Driever
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001772:Blood Cell Count; D006084:Graft Rejection / Q000139:chemically induced*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007958:Leukocyte Count; D000077287:Levetiracetam; D008297:Male; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000628:therapy; D010634:Phenobarbital / Q000627:therapeutic use; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy; D012640:Seizures / Q000150:complications / Q000188:drug therapy; D017211:Treatment Failure
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010634:Phenobarbital; D010889:Piracetam
keywords: Allogenic hematopoietic stem cell transplantation; Levetiracetam; Myelosuppression; Secondary graft failure