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Table 3 Clinical and treatment-related data for the 7 patients with cyclosporine A-related neurotoxicity

From: Cyclosporine A-related neurotoxicity after haploidentical hematopoietic stem cell transplantation in children with hematopathy

Patient number #1 #2 #3 #4 #5 #6 #7
Day of onset post-HSCT + 38 + 161 + 24 −3 + 1 + 46 + 137
Prodromes Transient headache, hypertension Vomiting, transient headache, hypertension Dysphoria, hypertension Fatigue, hypertension, visual hallucination Transient headache, vomiting Dysphoria, hypertension Fatigue
Acute symptoms Persistent headache, seizures Status epilepticus, tremors, dysphagia, persistent headache Status epilepticus, aphasia, tremors Status epilepticus, visual disturbance, psychosis Seizures, visual disturbance, persistent headache Status epilepticus Seizures
CSA level at time of neurotoxicity (ng/mL) 118.3 110 89.4 68.3 57.7 67.2 82.1
Maximum trough CSA level before CSA-related neurotoxicity (ng/mL) 307 500 135 211 107.8 118 584
Most severe GvHD grade before CSA-related neurotoxicity Grade II, skin and gut Grade III, skin and gut Grade II, skin No GvHD No GvHD Grade III, gut Grade IV, gut
Immune suppression after CSA-related neurotoxicity Tacrolimus, MMF, CS, basiliximab Tacrolimus, MMF, CS, basiliximab Tacrolimus, MMF, CS, basiliximab Tacrolimus, MMF Tacrolimus Tacrolimus, CS Tacrolimus, MMF, CS, basiliximab
Acute treatment for neurological symptoms Diazepam, midazolam, Diazepam, midazolam, trihexyphenidyl Diazepam, midazolam, sodium valproate, trihexyphenidyl Diazepam, midazolam, sodium valproate Diazepam, midazolam Diazepam, midazolam Diazepam, midazolam
Neurological sequelae None Secondary epilepsy Secondary epilepsy Psychosis None None
Chronic treatment/duration Nil Oxcarbazepine/3 years Oxcarbazepine/continuous Risperidone/2 years None None
Outcome/alast follow-up (days post-HSCT) Alive/+ 2023 Alive/+ 1909 Alive/+ 1818 Alive /+ 1899 Alive/+ 1798 Dead/+ 160 Alive/+ 958
Cause of death/current complications Symptom-free Symptom-free Secondary epilepsy Symptom-free Symptom-free Grade IV GvHD Symptom-free
  1. CS Corticosteroids, CSA Cyclosporine A, GvHD Graft-versus-host disease, HSCT Hematopoietic stem cell transplantation, MMF Mycophenolate mofetil. aAs of 15 November 2018, except for patient #6 for whom the last follow-up was 29 May 2016