Erer B, Polchi P, Lucarelli G, Angelucci E, Baronciani D, Galimberti M, Giardini C, Gaziev D, Maiello A
Divisione di Ematologica, Azienda Ospedaliera Di Pasaro, Italy.
Bone Marrow Transplant. 1996 Jul;18(1):157-62.
Cyclosporin A (CsA) has been shown to be useful in the prophylaxis of acute graft-versus-host-disease (GVHD). However, this immunosuppressive agent produces multiple side-effects including nephrotoxicity, hypertension, hypertricosis, gum hyperplasia, infections, and neurotoxicity. We report a retrospective analysis of neurotoxicity in 625 recipients transplanted for thalassemia and given CsA as part of GVHD prophylaxis. Neurotoxicity consisted in mental status changes, tremor, headache (grade 1), visual disturbance and cortical blindness (grade 2) and seizures and coma (grade 3). The overall toxicity was 28.8% and the incidence of convulsions was 10.1%. Neurological findings were reversible after temporary reduction or discontinuation of CsA. Class 3 patients, when prepared with protocol 6 (Bu 14 + Cy 200 and CsA for GVHD) or when they developed acute GVHD, had the highest risk of convulsions. Age, sex, different conditioning regimens, different anticonvulsive prophylaxis, liver damage due to iron-overload and/or to chronic inflammation did not influence the occurrence of CsA-related CNS toxicity. The occurrence of acute GVHD with concomitant use of high-dose corticosteroids is the single significant predisposing factor in the occurrence of convulsions. Grades 1 and 2 of neurotoxicity occurred earlier and were not influenced even by acute GVHD.
环孢素A（CsA）已被证明在预防急性移植物抗宿主病（GVHD）方面有用。然而，这种免疫抑制剂会产生多种副作用，包括肾毒性、高血压、多毛症、牙龈增生、感染和神经毒性。我们报告了对625例因地中海贫血接受移植并使用CsA作为GVHD预防措施一部分的受者的神经毒性进行的回顾性分析。神经毒性包括精神状态改变、震颤、头痛（1级）、视觉障碍和皮质盲（2级）以及癫痫发作和昏迷（3级）。总体毒性为28.8%，惊厥发生率为10.1%。在暂时减少或停用CsA后，神经学表现是可逆的。3级患者在采用方案6（Bu 14 + Cy 200和用于GVHD的CsA）预处理时或发生急性GVHD时，惊厥风险最高。年龄、性别、不同的预处理方案、不同的抗惊厥预防措施、铁过载和/或慢性炎症导致的肝损伤均不影响与CsA相关的中枢神经系统毒性的发生。同时使用高剂量皮质类固醇的急性GVHD的发生是惊厥发生的唯一重要易感因素。1级和2级神经毒性出现较早，甚至不受急性GVHD的影响。
