PMID- 9576643
OWN - NLM
STAT- MEDLINE
DCOM- 19980619
LR  - 20210807
IS  - 0195-6108 (Print)
IS  - 1936-959X (Electronic)
IS  - 0195-6108 (Linking)
VI  - 19
IP  - 4
DP  - 1998 Apr
TI  - The effect of human leukocyte antigen disparity on cyclosporine neurotoxicity 
      after allogeneic bone marrow transplantation.
PG  - 601-8; discussion 609-10
AB  - PURPOSE: We examined the relationship between human leukocyte antigen (HLA) 
      matching and the development of cyclosporine (CyA) neurotoxicity in patients 
      undergoing allogeneic bone marrow transplantation, and determined the frequency 
      and imaging characteristics of CyA neurotoxicity in these patients. METHODS: 
      Records of 87 patients who underwent allogeneic bone marrow transplantation were 
      reviewed. Eight patients who presented with visual disturbance and/or seizures 
      and had MR imaging within 24 hours were identified. Transplant donor relatedness 
      was examined, and patients' imaging studies were reviewed. Clinical parameters, 
      including blood pressure, CyA, creatinine, and magnesium levels, and the presence 
      of graft-versus-host disease were reviewed. RESULTS: CyA neurotoxicity was seen 
      more frequently in HLA-mismatched and unrelated donor transplants. The frequency 
      of CyA neurotoxicity was 4% for patients with a 5/6 or 6/6 HLA match, 13% for 
      matched unrelated donor transplants, and 50% for haplotypic 3/6 or 4/6 
      transplants. Patients with matched unrelated donor transplants and haplotypic 
      transplants presented earlier in the posttransplant time course and had decreased 
      survival time relative to patients with HLA-matched transplants. Imaging 
      abnormalities most commonly affected the occipital lobes and the posterior 
      cerebral hemispheres; both cortical and white matter involvement was identifiable 
      as T1 hypointense and T2 hyperintense signal with associated gyral swelling and 
      sulcal effacement on the initial MR studies. Hypodensity in the affected areas 
      was noted on CT scans. Contrast enhancement was seen in HLA-mismatched and 
      unrelated transplants only. Follow-up imaging showed interval decreases in 
      subcortical edema; however, residual signal abnormality, primarily affecting the 
      cortex, was present in all cases and seen best on proton density-weighted MR 
      images. CONCLUSION: The frequency of severe CyA neurotoxicity increases with 
      increasing HLA disparity, suggesting that immune factors may play a role. CyA 
      neurotoxicity appears to represent a spectrum of disease processes. Disruption of 
      the blood-brain barrier as well as hypoxic or vasculitic cortical injury 
      resulting in MR-detectable cortical signal abnormalities may occur in severe 
      cases.
FAU - Zimmer, W E
AU  - Zimmer WE
AD  - Department of Radiology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
FAU - Hourihane, J M
AU  - Hourihane JM
FAU - Wang, H Z
AU  - Wang HZ
FAU - Schriber, J R
AU  - Schriber JR
LA  - eng
PT  - Journal Article
PL  - United States
TA  - AJNR Am J Neuroradiol
JT  - AJNR. American journal of neuroradiology
JID - 8003708
RN  - 0 (HLA Antigens)
RN  - 0 (Immunosuppressive Agents)
RN  - 83HN0GTJ6D (Cyclosporine)
SB  - IM
MH  - Adult
MH  - *Bone Marrow Transplantation
MH  - Brain/diagnostic imaging/drug effects/pathology
MH  - Child
MH  - Cyclosporine/*adverse effects/therapeutic use
MH  - Female
MH  - HLA Antigens/*analysis
MH  - *Histocompatibility Testing
MH  - Humans
MH  - Immunosuppressive Agents/*adverse effects/therapeutic use
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Seizures/*chemically induced
MH  - Tomography, X-Ray Computed
MH  - Vision Disorders/*chemically induced
PMC - PMC8337412
EDAT- 1998/05/12 00:00
MHDA- 1998/05/12 00:01
PMCR- 1999/04/01
CRDT- 1998/05/12 00:00
PHST- 1998/05/12 00:00 [pubmed]
PHST- 1998/05/12 00:01 [medline]
PHST- 1998/05/12 00:00 [entrez]
PHST- 1999/04/01 00:00 [pmc-release]
PST - ppublish
SO  - AJNR Am J Neuroradiol. 1998 Apr;19(4):601-8; discussion 609-10.