[Acute lymphoblastic leukemia presenting with calcineurin-inhibitor induced pain syndrome after a second allogeneic bone marrow transplantation].

A 42-year-old woman was referred to us for the treatment of relapsed Philadelphia-positive acute lymphoblastic leukemia (Ph+ALL), which had been maintained in complete remission for seven years after an allogeneic bone marrow transplantation (allo-BMT) from an unrelated donor. She received remission-reinduction chemotherapy combined with imatinib mesylate. After the documentation of the molecular remission of Ph+ALL, she underwent the second allo-BMT from another unrelated donor. GVHD prophylaxis consisted of tacrolimus (TAC) and short-term methotrexate. On day 21, she suddenly suffered from an intermittent severe, cramp-like pain in the right lower limb. The typical pain profile and exclusion of other causative diseases suggested calcineurin-inhibitor induced pain syndrome (CIPS) as a possible cause of pain. The pain was gradually relieved after discontinuation of TAC and administration of several analgesic drugs. CIPS is rarely seen following allogeneic stem cell transplantation (allo-SCT); only three cases have been so far reported to our knowledge. Thus, physicians should be alert to this complication in patients receiving allo-SCT.
AuthorsShuichiro Takashima, Akihiko Numata, Toshihiro Miyamoto, Tsuyoshi Shirakawa, Rieko Kinoshita, Kouji Kato, Katsuto Takenaka, Naoki Harada, Koji Nagafuji, Shuichi Taniguchi, Mine Harada
Journal[Rinshò„ ketsueki] The Japanese journal of clinical hematology (Rinsho Ketsueki) Vol. 47 Issue 10 Pg. 1372-6 (Oct 2006) ISSN: 0485-1439 [Print] Japan
PMID17094576 (Publication Type: Case Reports, English Abstract, Journal Article)
Chemical References
  • Calcineurin Inhibitors
  • Calcineurin
  • Adult
  • Bone Marrow Transplantation
  • Calcineurin (adverse effects)
  • Calcineurin Inhibitors
  • Complex Regional Pain Syndromes (chemically induced)
  • Female
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma (therapy)
  • Transplantation Conditioning

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