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要旨 骨髄移植の経過中,免疫抑制剤 (cyclosporine, tacrolimus)による脳症が疑われた症例についてその臨床的特徴を検討した。対象疾患は,15歳以上で同種骨髄移植を行った,慢性および急性白血病(CML, ANLL, ALL)311例,骨髄異形成症候群(MDS)42例,重症再生不良性貧血(SAA)25例の計378症例。このうち脳症発症例は12例で,疾患別ではSAA, MDSで発症率が有意に高く(7例 ),典型的な画像変化を伴う明らかな脳症を示した症例は,SAAとSAAとの境界型であるhypoplastic MDSのみであった。また10例が死亡し,脳症非発症例より予後不良であった。SAA, MDSの7例中5例で,移植前にcyclosporineを内服しており,移植前の治療が脳症発症の要因となっている可能性が示唆された。
We studied clinical features of immunosuppressive (cyclosporine, tacrolimus) associated encephalopathy in bone marrow transplant patients. 378 cases of allogeneic bone marrow transplant recipients over fifteen years old of chronic and acute leukemia(CML, ANLL, ALL)(n=311), myelodysplastic syndrome (MDS) (n=42) and severe aplastic anemia(SAA)(n=25) were investigated. Immunosuppressive associated encephalopathy occurred in 12 cases. The rate of incidence was significantly higher in SAA and MDS(7 cases) than in leukemia. The cases which showed typical radiological abnormality in MRI were limited in SAA and hypoplastic MDS. 10 cases died, which revealed worse than an overall survival rate of recipients without immunosupressive-associated encephalopathy. 5 of 7 cases in SAA and MDS had taken cyclosporine as treatment of the disease before bone marrow transplantation and that might influence the incidence of encephalopathy.
(Received : January 13, 2004)
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