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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Medicine+(Baltimore)
2017 ; 96
(42
): e8303
Nephropedia Template TP
gab.com Text
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English Wikipedia
Case report: Central nervous system involvement of human graft versus host
disease: Report of 7 cases and a review of literature
#MMPMID29049232
Ruggiu M
; Cuccuini W
; Mokhtari K
; Meignin V
; Peffault de Latour R
; Robin M
; Fontbrune FS
; Xhaard A
; Socié G
; Michonneau D
Medicine (Baltimore)
2017[Oct]; 96
(42
): e8303
PMID29049232
show ga
RATIONALE: Central nervous system (CNS) involvement of graft versus host disease
(GvHD) is a rare cause of CNS disorders after allogeneic hematopoietic stem cell
transplantation (allo-HSCT). Chronic CNS GvHD symptoms are heterogeneous and
include cerebrovascular manifestations, demyelinating disease and immune-mediated
encephalitis. CNS-Acute GvHD is not formally defined in literature. PATIENTS
CONCERNS AND DIAGNOSES: We report 7 cases of CNS-GvHD among which two had
histological-proven disease. We reviewed 32 additional cases of CNS GvHD
published in literature since 1990. In this cohort, 34 patients were transplanted
for hematologic malignancies, and 5 for non-malignant hematopoiesis disorders. Of
these patients, 25 had a history of chronic GvHD and immunosuppressive treatment
had been decreased or discontinued in 14 patients before neurological symptoms
onset. Median neurological disorder onset was 385 days [7-7320]. Patients had
stroke-like episodes (n?=?7), lacunar syndromes (n?=?3), multiple sclerosis-like
presentations (n?=?7), acute demyelinating encephalomyelitis-like symptoms
(n?=?4), encephalitis (n?=?14), mass syndrome (n?=?1), and 3 had non-specific
symptoms. Median neurological symptoms onset was 81.5 days [7-1095] for patients
without chronic GVHD history versus 549 days [11-7300] for patients with chronic
GVHD (P?=?0.001). Patients with early involvement of CNS after allo-HSCT and no
chronic GVHD symptoms were more frequently suffering from encephalitis (64%
versus 28%, P?=?0.07), whereas stroke-like episodes and lacunar symptoms were
less frequent (9% versus 36%, P?=?0.13). INTERVENTIONS: 34 patients with CNS-GvHD
were treated with immunosuppressive therapy, including corticosteroids for 31 of
them. Other treatments were intravenous immunoglobulin, plasmapheresis,
cyclophosphamide, calcineurin inhibitors, mycophenolic acid, methotrexate and
etoposide. OUTCOMES: 27 patients achieved a response: 10 complete responses, 15
partial responses and 2 transient responses. Of 25 patients with sufficient
follow-up, 7 were alive and 18 patients deceased after CNS-GvHD diagnosis.
LESSONS: CNS-related GvHD is a rare cause of CNS disorders after allo-HSCT and is
associated with a poor prognosis.
|Adult
[MESH]
|Central Nervous System Diseases/drug therapy/*etiology/*physiopathology
[MESH]
|Female
[MESH]
|Graft vs Host Disease/drug therapy/*etiology/*physiopathology
[MESH]