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Danish A, Mughal SI, Zaidi U, et al. Frequency and Risk Factors of Cyclosporine-Induced Neurotoxicity in Allogeneic Stem Cell Transplant Recipients. Cureus. 2021;13(11):e19824doi: 10.7759/cureus.19824.
Danish, A., Mughal, S. I., Zaidi, U., Dildar, S., Samad, S., Jamal, A., Sharif, Z., & Shamsi, T. (2021). Frequency and Risk Factors of Cyclosporine-Induced Neurotoxicity in Allogeneic Stem Cell Transplant Recipients. Cureus, 13(11), e19824. https://doi.org/10.7759/cureus.19824
Danish, Asma, et al. "Frequency and Risk Factors of Cyclosporine-Induced Neurotoxicity in Allogeneic Stem Cell Transplant Recipients." Cureus vol. 13,11 (2021): e19824. doi: https://doi.org/10.7759/cureus.19824
Danish A, Mughal SI, Zaidi U, Dildar S, Samad S, Jamal A, Sharif Z, Shamsi T. Frequency and Risk Factors of Cyclosporine-Induced Neurotoxicity in Allogeneic Stem Cell Transplant Recipients. Cureus. 2021 Nov 22;13(11):e19824. doi: 10.7759/cureus.19824. eCollection 2021 Nov. PMID: 34963841; PMCID: PMC8696087.
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Cureus. 2021 Nov 22;13(11):e19824. doi: 10.7759/cureus.19824. eCollection 2021 Nov.

Frequency and Risk Factors of Cyclosporine-Induced Neurotoxicity in Allogeneic Stem Cell Transplant Recipients.

Cureus

Asma Danish, Sarah I Mughal, Uzma Zaidi, Shabnam Dildar, Shafaq Samad, Aisha Jamal, Zainab Sharif, Tahir Shamsi

Affiliations

  1. Department of Clinical Hematology, National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, PAK.
  2. Department of Research and Development, National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, PAK.
  3. Department of Bone Marrow Transplantation, National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, PAK.
  4. Chemical Pathology, National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, PAK.
  5. Hematology, National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, PAK.

PMID: 34963841 PMCID: PMC8696087 DOI: 10.7759/cureus.19824

Abstract

Background and objective The calcineurin inhibitor cyclosporine A is routinely used for prophylaxis against graft-versus-host-disease (GvHD) in human leukocyte antigen (HLA)-matched allogeneic stem-cell transplant patients and is a major etiological factor for neuropathological symptoms that are reversible in most cases. In this study, we aimed to determine the frequency and risk factors of cyclosporine-induced neurotoxicity (CIN) in HLA-matched allogeneic stem cell transplant patients. Methods The study spanned the period from January 2016 to December 2019. Consecutive HLA-matched allogeneic stem-cell transplant patients of all ages were included in the study. Descriptive and risk factor analyses for the development of CIN with respect to age, sex, primary diagnosis, conditioning regimen, electrolyte abnormalities, and cyclosporine trough levels during the neurological episode were performed. Results A total of 106 HLA-matched patients with a median age of 6.3 years [interquartile range (IQR): 0.5-46 years], of which 37 (35%) were females, were included in the study. The mean cyclosporine trough level was 500 ±286 mg/dl. Neurological symptoms were found in 27 (26%) patients. A total of 14 (13%) patients were diagnosed with CIN. The frequency of other neurological symptoms included headache in 46 (43%), disorientation in 17 (16%), seizures in 12 (11%), visual disturbance in 11 (10%), and aphasia in seven (7%) patients. Posterior reversible encephalopathy syndrome (PRES) was found in six (6%) patients. All patients with CIN had hypertension and none had a fever. Multivariate logistic analysis showed that the presence of seizures [odds ratio (OR): 10.0, p<0.001] and the absence of fever (OR: 0.02, p<0.001) were associated with the diagnosis of CIN. Conclusion The prevalence of CIN is not uncommon (13%) in patients receiving cyclosporine for GvHD prophylaxis. Neurological complications, especially seizures, are common in CIN, and fever might indicate an alternative diagnosis. Prompt recognition of neurological signs and symptoms and early intervention can halt the progression of the disease.

Copyright © 2021, Danish et al.

Keywords: cyclosporine a; cyclosporine induced neurotoxicity (cin); neurological complications; posterior reversible encephalopathy syndrome (pres); stem-cell transplant

Conflict of interest statement

The authors have declared that no competing interests exist.

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