Severe vascular and neurological complications after hematopoietic stem cell transplantation with reduced intensity conditioning Case report
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Abstract
It is well established that the benefit of myeloablative ALLO-HSCT can be associated with a potential high risk of procedure-related toxicity. The objective of this report is the analysis of complications in a 17-year-old girl with AML previously treated for medulloblastoma and myelodysplastic syndrome. Thiotepa, fludarabine, treosulfan and thymoglobuline were used in conditioning regimen. During conditioning neurological complications have occurred. MRI and CT scan results revealed the coexistence of PRES with the left internal carotid artery thrombosis. The effect of fludarabine on endothelial cells could possibly contribute to irreversible CNS damage and death in presented case.
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Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
2. Barba P, Pinana JL, Valcarcel D et al. Early and late neurological complications after reduced-intensity conditioning allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2009; 15(11): 1439-1446.
3. Beitinjaneh A, McKinney AM, Cao Q et al. Toxic leukoencephalopathy following fludarabine-associated hematopoietic cell transplantation. Biol Blood Marrow Transplant 2011; 17(3): 300-308.
4. Annaloro C, Costa A, Fracchiolla NS et al. Severe fludarabine neurotoxicity after reduced intensity conditioning regimen to allogeneic hematopoietic stem cell transplantation: a case report. Clin Case Rep 2015; 3(7): 650-655.
5. Lee MS, McKinney AM, Brace JR et al. Clinical and imaging features of fludarabine neurotoxicity. J Neuroophthalmol 2010; 30(1): 37-41.
6. Johnson PW, Fearnley J Domizio P et al. Neurological illness following treatment with fludarabine. Br J Cancer 1994; 70(5): 966-968.
7. McKinney AM, Short J, Truwit CL et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol 2007; 189(4): 904-912.
8. Granata G., Greco A, Iannella G et al. Posterior reversible encephalopathy syndrome--Insight into pathogenesis, clinical variants and treatment approaches. Autoimmun Rev 2015; 14(9): 830-836.
9. Poreba M, Gac P, Usnarska-Zubkiewicz L et al. Endothelial Function in Patients with Hematologic Malignancies Undergoing High-Dose Chemotherapy Followed by Hematopoietic Stem Cell Transplantation. Cardiovasc Toxicol 2016; 16(2): 156-162.
10. Shimoni A, Yeshurun M, Hardan I et al. Thrombotic microangiopathy after allogeneic stem cell transplantation in the era of reduced-intensity conditioning: The incidence is not reduced. Biol Blood Marrow Transplant 2004; 10(7): 484-493.
11. Martin GG, Fernandez SP, Castro VS et al. Vertebral artery occlusion after chemotherapy. Stroke 2008; 39(2): e38; author reply e39.
12. Dengel DR, Ness KK, Glasser SP et al. Endothelial function in young adult survivors of childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2008; 30(1): 20-25.
13. Ellchuk TN, Shah LM, Hewlett RH et al. Suspicious neuroimaging pattern of thrombotic microangiopathy. AJNR Am J Neuroradiol 2011; 32(4): 734-738.
14. Hefzy HM, Bartynski WS, Boardman JF et al. Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol 2009; 30(7): 1371-1379.
15. Eder S, Labopin M, Finke J et al. Safety and efficacy of thiotepa-based conditioning for allogeneic transplantation in AML: a survey from the ALWP of the EBMT. Bone Marrow Transplant 2017; 52(2): 238-244.
16. Boztug H, Zecca M, Sykora KW et al. Treosulfan-based conditioning regimens for allogeneic HSCT in children with acute lymphoblastic leukaemia. Ann Hematol 2015; 94(2): 297-306.
17. Slatter MA, Boztug H, Potschger U et al. Treosulfan-based conditioning regimens for allogeneic haematopoietic stem cell transplantation in children with non-malignant diseases. Bone Marrow Transplant 2015; 50(12): 1536-1541.