Objective: To investigate the morbidity, clinical manifestations, and imageology characteristics, and the influencing factors of severe cyclosporine A (CsA)-related neurotoxicity (SNCT) in the patients after allogenic hematopoietic stem cell transplantation (allo-HSCT).
Methods: Finding of SNCT was carried out in 164 allo-HSCT recipients from January 2003 to June 2006. Clinical characteristics were analysed, including precursory symptoms and clinical manifestations. Associations between the onset of SNCT with blood CsA levels, age, transplant types, human leucocyte antigen (HLA) matching, conditioning regimens, antihuman thymocyte globulin (ATG) used in the prevention and treatment for graft-versus-host disease (GVHD) and intravenous corticosteroid used for acute GVHD were analyzed. Statistical analysis was performed with Binary Logistic Regression using SPSS/PC version 11.0.
Results: Thirteen patients (7.93%) were identified to have SNCT, including seizures (n = 8, 4.88%), paralysis (n = 6, 3.66%), coma (n = 2, 1.22%), cerebellar ataxia (n = 3, 1.83%) and chondroid encephalomyopathy (n = 1, 0.61%). All the patients had precursory symptoms prior SNCT including headache (n = 8), agitation (n = 4) and hypertension (n = 6). Magnetic resonance imaging (MRI) performed in twelve patients after SNCT showed that eleven patients had signal abnormalities in cerebral cortex and cerebral white matter. Six patients examined with computerized tomography (CT) had no abnormal findings. After extenuation or withdrawal of CsA, ten patients had complete recovery, two had partial recovery and one died of SNCT. Simple effect analysis of Binary Logistic Regression showed that the associations between the onset of SNCT with blood CsA levels, transplant types, HLA matching, ATG used in the prevention and treatment for GVHD and intravenous corticosteroid used for acute GVHD were of statistical significance. The multiple effect analysis of Binary Logistic Regression showed that the associations of the onset of SNCT with blood CsA levels and ATG used had statistical significance and the odds ratio (OR) was 1.007 (P = 0.006) and 6.727 (P = 0.030), respectively.
Conclusions: 91.67% of the allo-HSCT recipients with SNCT have MRI abnormalities. High blood CsA levels and the use of ATG can elevate the risk of the occurrence of SNCT.