title: Clinical Management of Posterior Reversible Encephalopathy Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation: A Case Series and Review of the Literature.
abstract: BACKGROUND
  Posterior reversible encephalopathy syndrome (PRES) is a rare but serious complication after allogeneic hematopoietic stem cell transplantation (alloHSCT). Among others, calcineurin inhibitors (CNI) for prophylaxis of graft-versus-host disease (GvHD) may promote the development of PRES, but the pathomechanism is still controversial. Discontinuation of CNI facilitates remission of symptoms but might contribute to the unfavorable prognosis of PRES due to an elevated incidence of GvHD.
  
  
  METHODS
  This is a case series of 7 patients with PRES from a retrospective analysis of 146 consecutive patients who received alloHSCT for hematologic malignancies.
  
  
  RESULTS
  At the onset of PRES, all patients presented a systemic infection, while no influence was seen for underlying disease, conditioning regimen, donor type, or GvHD. Discontinuation of CNI and control of the blood pressure reversed neurological symptoms in 6 patients, while 1 patient died from septic multiorgan failure. After bridging with prednisolone and/or mycophenolic acid, replacement of CNI by the mammalian target of rapamycin (mTOR) inhibitor everolimus effectively prevented severe GvHD without recurrence of PRES.
  
  
  CONCLUSIONS
  A systemic infection/inflammation may be an important cause of PRES. Prophylaxis of GvHD by the mTOR inhibitor everolimus in case of PRES after alloHSCT demonstrated promising results but needs to be validated in larger cohorts.
authors.affiliation: Abteilung Hx00E4;matologie und Internistische Onkologie, Klinik fx00FC;r Innere Medizin II, Universitx00E4;tsklinikum Jena, Jena, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Schmidt
authors.forename: Tino
authors.initials: T
authors.lastname: Prell
authors.forename: Anne
authors.initials: A
authors.lastname: Treschl
authors.forename: Anne
authors.initials: A
authors.lastname: Klink
authors.forename: Andreas
authors.initials: A
authors.lastname: Hochhaus
authors.forename: Herbert G
authors.initials: HG
authors.lastname: Sayer
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D001927:Brain Diseases / Q000209:etiology / Q000378:metabolism / Q000401:mortality / Q000517:prevention & control; D065095:Calcineurin Inhibitors / Q000008:administration & dosage; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality; D019337:Hematologic Neoplasms / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007239:Infections / Q000150:complications / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013577:Syndrome; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors / Q000378:metabolism
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases