Neurological complications following alemtuzumab-based reduced-intensity allogeneic transplantation
Neurological complications following alemtuzumab-based reduced-intensity allogeneic transplantation
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DOI：
10.1038/sj.bmt.1704538
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发表时间：
2004-07-01
影响因子：
4.8
通讯作者：
Mackinnon, S
中科院分区：
文献类型：
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作者：
Avivi, I;Chakrabarti, S;Mackinnon, S
我们报告了85例接受亲缘/非亲缘供者干细胞移植的患者在使用阿仑珠单抗、氟达拉滨和马法兰治疗后，在低强度预适应(RIC)后发生的神经系统并发症的发生率、特征和结果。6名患者(概率为8.9%)在中位时间151天(24-334天)出现严重的神经系统并发症。其中5人表现为进行性周围感觉运动神经病变和/或脊髓炎，在此之前有一种或多种病毒激活/感染。尽管接受了免疫球蛋白/血浆置换/类固醇治疗，但仍有4人死于进行性周围神经麻痹所致的呼吸衰竭。病毒感染被确定为发展神经并发症的唯一危险因素。接受基于阿仑单抗的RIC治疗的患者发生与方案相关的神经并发症的风险较低，但更容易发生周围神经根神经病或脊髓炎。这种现象可能与病毒感染有关，与免疫恢复延迟或由阿伦图珠单抗诱导的T细胞耗尽引起的免疫失调有关。
We report the incidence, characteristics and outcome of neurological complications occurring following reduced-intensity conditioning (RIC) in 85 patients who received a related/unrelated donor stem cell transplantation following therapy with alemtuzumab, fludarabine and melphalan. Six patients (probability 8.9%) developed severe neurological complications at a median of 151 days (24-334 days). Five of them presented with progressive peripheral sensori-motor radiculo-neuropathy and/or myelitis, preceded by one or more viral reactivation/infection. Despite treatment with immunoglobulins/plasmapheresis/steroids, four died of respiratory failure due to progressive peripheral neurophathy. Viral infection was identified as the only risk factor for the development of neurological complications. Patients who are treated with alemtuzumab-based RIC may have a lower risk of developing regimen-related neurological complications, but are more susceptible to develop peripheral radiculo-neuropathy or myelitis. This phenomenon may be possibly related to viral infection associated with delayed immunological recovery or immunological dysregulation caused by alemtuzumab-induced T-cell depletion.