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