Chohan Rizwana, Vij Ravi, Adkins Douglas, Blum William, Brown Randy, Tomasson Michael, Devine Steven, Graubert Timothy, Goodnough Lawrence T, DiPersio John F, Khoury Hanna
Washington University School of Medicine, Department of Medicine, Division of Oncology, Section of Leukaemia & Bone Marrow Transplantation, St Louis, MO 63110-1093, USA.
Br J Haematol. 2003 Oct;123(1):110-3. doi: 10.1046/j.1365-2141.2003.04550.x.
Calcineurin inhibitor-induced central nervous system toxicities are uncommon and often resolve after discontinuation of the offending drug. The long-term outcome of these patients is, however, unknown. Resolution of symptoms occurred in 70% of 30 allografted recipients who developed calcineurin inhibitor-induced neurotoxicity. When patients were rechallenged with the same or a different calcineurin inhibitor, symptoms recurred in 41%, leading to permanent discontinuation of the drug. De novo or progressive acute graft-versus-host disease (GVHD) was observed in 54% of patients at a median of 7 d (range 1-70 d) after initial onset of neurotoxicity. The prognosis was grim, with 24 (80%) of these patients dying a median 33 d after the onset of neurotoxicity (range 2-594 d). GVHD and/or infection occurred in 54% and were the most common primary causes of death. We conclude that calcineurin inhibitor-induced neurotoxicity is frequently reversible but associated with a poor prognosis.
钙调神经磷酸酶抑制剂引起的中枢神经系统毒性并不常见，通常在停用相关药物后症状会缓解。然而，这些患者的长期预后尚不清楚。30例发生钙调神经磷酸酶抑制剂诱导的神经毒性的同种异体移植受者中，70%的患者症状得到缓解。当患者再次使用相同或不同的钙调神经磷酸酶抑制剂时，41%的患者症状复发，导致药物永久停用。在神经毒性首次发作后的中位时间为7天（范围1 - 70天）时，54%的患者出现了新发或进行性急性移植物抗宿主病（GVHD）。预后严峻，这些患者中有24例（80%）在神经毒性发作后的中位时间为33天（范围2 - 594天）死亡。GVHD和/或感染发生率为54%，是最常见的主要死亡原因。我们得出结论，钙调神经磷酸酶抑制剂诱导的神经毒性通常是可逆的，但预后较差。
