PT  - JOURNAL ARTICLE
AU  - Bartynski, Walter S.
AU  - Zeigler, Zella R.
AU  - Shadduck, Richard K.
AU  - Lister, John
TI  - Pretransplantation Conditioning Influence on the Occurrence of Cyclosporine or FK-506 Neurotoxicity in Allogeneic Bone Marrow Transplantation
DP  - 2004 Feb 01
TA  - American Journal of Neuroradiology
PG  - 261--269
VI  - 25
IP  - 2
4099  - http://www.ajnr.org/content/25/2/261.short
4100  - http://www.ajnr.org/content/25/2/261.full
SO  - Am. J. Neuroradiol.2004 Feb 01; 25
AB  - BACKGROUND AND PURPOSE: Transplantation conditioning regimens have been shown to affect the brain imaging appearance in patients with cyclosporine or FK-506 neurotoxicity. We assessed whether the occurrence of neurotoxicity was affected by the choice of conditioning regimen used before allogeneic bone marrow transplantation (allo-BMT).METHODS: An allo-BMT was performed in 290 patients conditioned before transplantation with myeloablative therapy. Neurotoxicity from cyclosporine or FK-506 developed in 21 (7.2%) of these patients, as confirmed with CT or MR imaging. Two hundred seventy-four (94%) of these 290 patients were conditioned with minor variations of one of five fundamental regimens: cyclophosphamide (Cy)/busulfan (n = 97), Cy/total body irradiation (TBI) (n = 122), Cy/thiotepa/TBI (n = 40), bischloroethylnitrosourea/etoposide/cytarabine/melphalan, or BEAM (n = 10), and Cy/thiotepa/busulfan (n = 5). The remaining 16 patients were prepared with variable regimens. The rates of occurrence of cyclosporine or FK-506 neurotoxicity relative to these conditioning regimens were compared.RESULTS: The lowest rate of cyclosporine or FK-506 neurotoxicity was found in those patients conditioned with Cy (2 days)/busulfan (4 days) (5.1%) or Cy (2 days)/TBI (4 days) (5.9%). Rate of neurotoxicity increased with lengthier conditioning regimens. A high rate of neurotoxicity was present in those patients conditioned with Cy (4 days)/TBI (4 days) (13.7%), and this was statistically significant (P < .05) when compared with Cy (2 days)/busulfan (4 days).CONCLUSION: The rate of occurrence of cyclosporine or FK-506 neurotoxicity varies with the conditioning regimen used, with lengthier regimens associated with a higher rate of neurotoxicity. As the length of the conditioning regimen equates to the total dose of chemotherapy administered, it suggests that the intensity of the regimen is correlated to the predisposition to neurotoxicity from cyclosporine or FK-506.