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Bryan S, Witzel I, Borgmann K, Oliveira-Ferrer L. Molecular Mechanisms Associated with Brain Metastases in HER2-Positive and Triple Negative Breast Cancers. Cancers (Basel) 2021; 13:4137. [PMID: 34439289 PMCID: PMC8392331 DOI: 10.3390/cancers13164137] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022] Open
Abstract
Breast cancer (BC) is the most frequent cause of cancer-associated death for women worldwide, with deaths commonly resulting from metastatic spread to distant organs. Approximately 30% of metastatic BC patients develop brain metastases (BM), a currently incurable diagnosis. The influence of BC molecular subtype and gene expression on breast cancer brain metastasis (BCBM) development and patient prognosis is undeniable and is, therefore, an important focus point in the attempt to combat the disease. The HER2-positive and triple-negative molecular subtypes are associated with an increased risk of developing BCBM. Several genetic and molecular mechanisms linked to HER2-positive and triple-negative BC breast cancers appear to influence BCBM formation on several levels, including increased development of circulating tumor cells (CTCs), enhanced epithelial-mesenchymal transition (EMT), and migration of primary BC cells to the brain and/or through superior local invasiveness aided by cancer stem-like cells (CSCs). These specific BC characteristics, together with the ensuing developments at a clinical level, are presented in this review article, drawing a connection between research findings and related therapeutic strategies aimed at preventing BCBM formation and/or progression. Furthermore, we briefly address the critical limitations in our current understanding of this complex topic, highlighting potential focal points for future research.
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Affiliation(s)
- Sarah Bryan
- Department of Gynaecology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (S.B.); (I.W.)
| | - Isabell Witzel
- Department of Gynaecology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (S.B.); (I.W.)
| | - Kerstin Borgmann
- Center of Oncology, Laboratory of Radiobiology & Experimental Radiooncology, Department of Radiotherapy and Radiooncology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Leticia Oliveira-Ferrer
- Department of Gynaecology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (S.B.); (I.W.)
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Winter SF, Martinez-Lage M, Clement NF, Hochberg EP, Dietrich J. Fatal neurotoxicity after chimeric antigen receptor T-cell therapy: An unexpected case of fludarabine-associated progressive leukoencephalopathy. Eur J Cancer 2020; 144:178-181. [PMID: 33360262 DOI: 10.1016/j.ejca.2020.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/15/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Sebastian F Winter
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA; Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Maria Martinez-Lage
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nathan F Clement
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ephraim P Hochberg
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jorg Dietrich
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA; Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Ozturk K, Rykken J, McKinney AM. Pediatric Acute Toxic Leukoencephalopathy: Prediction of the Clinical Outcome by FLAIR and DWI for Various Etiologies. AJNR Am J Neuroradiol 2020; 41:1517-1524. [PMID: 32616577 DOI: 10.3174/ajnr.a6624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/30/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pediatric acute toxic leukoencephalopathy is a clinicoradiologic entity comprising various etiologies. This study aimed to identify the MR imaging appearance of pediatric acute toxic leukoencephalopathy from various etiologies and determine whether the etiology correlates with clinical outcome. MATERIALS AND METHODS We retrospectively reviewed the electronic records of patients with pediatric acute toxic leukoencephalopathy younger than 19 years of age who had MR imaging within <2 weeks of presentation, including DWI and FLAIR sequences. Two neuroradiologists scored the DWI and FLAIR severity and measured the percentage ADC reduction within the visibly affected regions and normal-appearing WM. The percentage ADC reduction and DWI and FLAIR severity were correlated with clinical outcome using the Spearman correlation. RESULTS Of 22 children, 3 were excluded due to a nontoxic cause or incomplete examination. Regarding the included 19 children (mean age, 13 years), the etiologies of pediatric acute toxic leukoencephalopathy were the following: methotrexate (n = 6), bone marrow transplantation (n = 4), fludarabine (n = 3), cytarabine (n = 1), carboplatin (n = 1), vincristine (n = 1), cyclosporine (n = 1), uremia (n = 1), and bevacizumab (n = 1). Three subgroups were analyzed (chemotherapy, n = 12; immunosuppression, n = 5; others, n = 2). There was a strong correlation of FLAIR (r = 0.773, P < .001) and DWI (r = 0.851, P < .001) severity with clinical outcome, and patients treated with fludarabine had the worst outcomes. High percentage ADC reduction values were associated with adverse outcomes, and lower percentage ADC reduction values were associated with favorable outcomes (r = 0.570, P = .011). CONCLUSIONS The DWI and FLAIR severity scores appear highly prognostic, whereas percentage ADC reduction is moderately prognostic for clinical outcomes in pediatric acute toxic leukoencephalopathy. Immunosuppressive pediatric acute toxic leukoencephalopathy tends toward favorable outcomes, and fludarabine tends toward worse outcomes.
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Affiliation(s)
- K Ozturk
- From the Department of Radiology, University of Minnesota, Minneapolis, Minnesota.
| | - J Rykken
- From the Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - A M McKinney
- From the Department of Radiology, University of Minnesota, Minneapolis, Minnesota
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Koksel Y, Ozutemiz C, Rykken J, Ott F, Cayci Z, Oswood M, McKinney AM. "CHOICES": An acronym to aid in delineating potential causes of non-metabolic, non-infectious acute toxic leukoencephalopathy. Eur J Radiol Open 2019; 6:243-257. [PMID: 31309133 PMCID: PMC6607360 DOI: 10.1016/j.ejro.2019.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/16/2019] [Accepted: 06/24/2019] [Indexed: 12/18/2022] Open
Abstract
Recognition the etiologies of ATL is important due to its potentially reversible nature after treatment or removal of the toxin. “CHOICES” is useful to memorize etiologies associated with PVWM injury in non-metabolic and non-infectious ATL patients. Reduced diffusion is an early and important imaging finding to evaluate patients with non-metabolic and non-infectious ATL patients.
Purpose To describe non-metabolic, non-infectious etiologies of acute toxic leukoencephalopathy (ATL) on DWI MRI, and provide a useful acronym to remember them. Material and Methods Our PACS archive was reviewed, yielding 185 patients with suspected ATL per MRI reports and clinical follow up; infectious or metabolic causes were excluded. Result/Discussion The 87 included non-infectious, non-metabolic ATL patients' etiologies are represented by the acronym 'CHOICES': chemotherapy ('C',n = 34); heroin-induced ('H',n = 6), opioid analogues ('O',n = 14); immunosuppressant ('I',n = 11) or imidazole (n = 2); cocaine ('C',n = 1); environmental or ethanol abuse ('E',n = 5), splenial lesions ('S',n = 9), and 'other' (n = 5). Conclusion The "CHOICES" acronym delineates various toxic etiologies of ATL.
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Key Words
- ADEM, Acute disseminated encephalomyelitis
- AEDs, Anti-epileptic drugs
- AHE, Acute Hepatic/Hyperammonemic Encephalopathy
- AHL, Acute hemorrhagic leukoencephalitis
- ATL, Acute toxic leukoencephalopathy
- Acute toxic leukoencephalopathy
- CO, Carbon monoxide
- Diffusion-Weighted imaging
- EPM, Extrapontine myelinolysis
- EtOH, Ethanol
- HIE, Hypoxic-ischemic encephalopathy
- LE, leukoencephalopathy
- MBD, Marchiafava-Bignami Disease
- MERS, Mild encephalitis/encephalopathy with reversible splenial lesion
- NAWM, Normal-appearing white matter
- ODS, Osmotic demyelination syndrome
- PML, Progressive multifocal leukoencephalopathy
- PRES, Posterior reversible encephalopathy syndrome
- PVWM, Periventricular white matter
- Periventricular white matter
- RIS, Radiology information system
- RSL, Reversible splenial lesions
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Affiliation(s)
- Yasemin Koksel
- Department of Radiology, Division of Neuroradiology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Can Ozutemiz
- Department of Radiology, Division of Neuroradiology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Jeffrey Rykken
- Department of Radiology, Division of Neuroradiology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Frederick Ott
- Department of Radiology, Division of Neuroradiology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Zuzan Cayci
- Department of Radiology, Division of Neuroradiology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Mark Oswood
- Department of Radiology, Division of Neuroradiology Hennepin Healthcare Medical Center, Minneapolis, MN, USA
| | - Alexander M McKinney
- Department of Radiology, Division of Neuroradiology, University of Minnesota Medical Center, Minneapolis, MN, USA
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Visual loss secondary to fludarabine toxicity: optical coherence tomography findings in two patients. Eye (Lond) 2019; 33:1023-1025. [PMID: 30692648 DOI: 10.1038/s41433-019-0343-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/07/2019] [Indexed: 11/08/2022] Open
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Özütemiz C, Roshan SK, Kroll NJ, Benson JC, Rykken JB, Oswood MC, Zhang L, McKinney AM. Acute Toxic Leukoencephalopathy: Etiologies, Imaging Findings, and Outcomes in 101 Patients. AJNR Am J Neuroradiol 2019; 40:267-275. [PMID: 30679224 DOI: 10.3174/ajnr.a5947] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/03/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prior studies regarding acute toxic leukoencephalopathy (ATL) are either small, or preliminary. Our aim was to evaluate etiologies of and differences in imaging severity and outcomes among various etiologies of ATL. MATERIALS AND METHODS MRIs of patients with suspected ATL over 15 years were retrospectively reviewed; inclusion criteria were: MRI <3 weeks of presentation with both DWI and FLAIR. These were jointly graded by two neuroradiologists via a previously described score of severity. Clinical outcome was evaluated via both modified Rankin (mRS) and ATL outcome (ATLOS) scores, each being correlated with the DWI and FLAIR scores. Etiologic subgroups of n > 6 patients were statistically compared. RESULTS Of 101 included patients, the 4 subgroups of n > 6 were the following: chemotherapy (n = 35), opiates (n = 19), acute hepatic encephalopathy (n = 14), and immunosuppressants (n = 11). Other causes (n = 22 total) notably included carbon monoxide (n = 3) metronidazole (n = 2), and uremia (n = 1). The mean DWI/FLAIR severity scores were 2.6/2.3, 3.3/3.3, 2.1/2.1 and 2.0/2.5 for chemotherapeutics, opiates, AHE and immunosuppressants, respectively, with significant differences in both imaging severity and outcome (P = .003-.032) among subgroups, particularly immunosuppressant versus chemotherapy-related ATL and immunosuppressants versus opiates (P = .004-.032) related ATL. DWI and FLAIR severity weakly correlated with outcome (ρ = 0.289-.349, P < .005) but correlated stronger in the chemotherapy (ρ = 0.460-.586, P < .010) and opiate (ρ =.472-.608, P < .05) subgroups, which had the worst outcomes. ATL clinically resolved in 36%, with severe outcomes in 23% (coma or death, 9/16 deaths from fludarabine). Notable laboratory results were elevated CSF myelin basic protein levels in 8/9 patients and serum blood urea nitrogen levels in 24/91. CONCLUSIONS Clinical outcomes of ATL vary on the basis of etiology, being worse in chemotherapeutic- and opiate-related ATL. Uremia may be a predisposing or exacerbating factor.
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Affiliation(s)
- C Özütemiz
- From the Department of Radiology (C.Ö., S.K.R., J.C.B., J.B.R., A.M.M.)
| | - S K Roshan
- From the Department of Radiology (C.Ö., S.K.R., J.C.B., J.B.R., A.M.M.)
| | - N J Kroll
- Faculty of Medicine (N.J.K.), University of Minnesota, Minneapolis, Minnesota
| | - J C Benson
- From the Department of Radiology (C.Ö., S.K.R., J.C.B., J.B.R., A.M.M.)
| | - J B Rykken
- From the Department of Radiology (C.Ö., S.K.R., J.C.B., J.B.R., A.M.M.)
| | - M C Oswood
- Department of Radiology (M.C.O.), Hennepin County Medical Center, Minneapolis, Minnesota
| | - L Zhang
- Biostatistics Design and Analysis Center (L.Z.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - A M McKinney
- From the Department of Radiology (C.Ö., S.K.R., J.C.B., J.B.R., A.M.M.)
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Fludarabine-Induced Posterior Reversible Encephalopathy Syndrome in a Pediatric Patient With β-Thalassemia: Case Report and Literature Review. Clin Neuropharmacol 2018; 41:224-229. [PMID: 30273191 DOI: 10.1097/wnf.0000000000000309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Posterior reversible encephalopathy syndrome is a disorder of reversible subcortical vasogenic brain edema in the context of different diseases or exposure to cytotoxic drugs such as fludarabine. We present the case of a pediatric patient with β-thalassemia who develops a fludarabine-induced posterior reversible encephalopathy while he received an induction regimen to achieve an allogenic hematopoietic cell transplantation. The clinical presentation consists in altered mental state, headache, status epilepticus, visual disturbance, and hypertension. His treatment was carried out with the suspension of the medication and the control of hypertension and status epilepticus; the final outcome was positive without additional complications. There are published reports about fludarabine toxicity in the central nervous system with different doses of the drug in different clinical context. We also made a review of the literature available and conclude that fludarabine is not an extraordinary cause of posterior reversible encephalopathy syndrome.
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Vaubel RA, Ross Reichard R. A 56-year-old woman with blindness and mental status changes. Brain Pathol 2018; 28:583-584. [PMID: 30133867 DOI: 10.1111/bpa.12623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rachael A Vaubel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - R Ross Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Xing F, Liu Y, Wu SY, Wu K, Sharma S, Mo YY, Feng J, Sanders S, Jin G, Singh R, Vidi PA, Tyagi A, Chan MD, Ruiz J, Debinski W, Pasche BC, Lo HW, Metheny-Barlow LJ, D'Agostino RB, Watabe K. Loss of XIST in Breast Cancer Activates MSN-c-Met and Reprograms Microglia via Exosomal miRNA to Promote Brain Metastasis. Cancer Res 2018; 78:4316-4330. [PMID: 30026327 PMCID: PMC6072593 DOI: 10.1158/0008-5472.can-18-1102] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 12/15/2022]
Abstract
Up to 30% of patients with metastatic breast cancer eventually develop brain metastasis, yet the pathologic mechanism behind this development remains poorly understood. Here, we profiled long noncoding RNAs in brain metastatic tumors from patients with breast cancer and found that the X-inactive-specific transcript (XIST) was significantly downregulated in these tissues. XIST expression levels inversely correlated with brain metastasis, but not with bone metastasis in patients. Silencing of XIST preferentially promoted brain metastatic growth of XISThigh cells in our xenograft models. Moreover, knockout of XIST in mice mammary glands accelerated primary tumor growth as well as metastases in the brain. Decreased expression of XIST stimulated epithelial-mesenchymal transition and activated c-Met via MSN-mediated protein stabilization, which resulted in the promotion of stemness in the tumor cells. Loss of XIST also augmented secretion of exosomal miRNA-503, which triggered M1-M2 polarization of microglia. This M1-M2 conversion upregulated immune suppressive cytokines in microglia that suppressed T-cell proliferation. Furthermore, we screened an FDA-approved drug library and identified fludarabine as a synthetic lethal drug for XISTlow breast tumor cells and found that fludarabine blocked brain metastasis in our animal model. Our results indicate that XIST plays a critical role in brain metastasis in breast cancer by affecting both tumor cells and the tumor microenvironment and that the XIST-mediated pathway may serve as an effective target for treating brain metastasis.Significance: These findings describe mechanisms of how loss of the lncRNA XIST promotes brain metastasis in breast cancer and identify fludarabine as a potential therapeutic agent that specifically eliminates XISTlow tumor cells in the brain. Cancer Res; 78(15); 4316-30. ©2018 AACR.
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Affiliation(s)
- Fei Xing
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina.
| | - Yin Liu
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Shih-Ying Wu
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Kerui Wu
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Sambad Sharma
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Yin-Yuan Mo
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jiamei Feng
- Mammary Department, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Stephanie Sanders
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Guangxu Jin
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Ravi Singh
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Pierre-Alexandre Vidi
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Abhishek Tyagi
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Jimmy Ruiz
- Department of Hematology & Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Waldemar Debinski
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Boris C Pasche
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Hui-Wen Lo
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Linda J Metheny-Barlow
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Ralph B D'Agostino
- Biostatistical Sciences Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina.
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Lowe KL, Mackall CL, Norry E, Amado R, Jakobsen BK, Binder G. Fludarabine and neurotoxicity in engineered T-cell therapy. Gene Ther 2018; 25:176-191. [DOI: 10.1038/s41434-018-0019-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/25/2018] [Accepted: 03/09/2018] [Indexed: 12/13/2022]
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Cordelli DM, Masetti R, Zama D, Toni F, Castelli I, Ricci E, Franzoni E, Pession A. Central Nervous System Complications in Children Receiving Chemotherapy or Hematopoietic Stem Cell Transplantation. Front Pediatr 2017; 5:105. [PMID: 28555178 PMCID: PMC5430164 DOI: 10.3389/fped.2017.00105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/25/2017] [Indexed: 01/19/2023] Open
Abstract
Therapy-related neurotoxicity greatly affects possibility of survival and quality of life of pediatric patients treated for cancer. Central nervous system (CNS) involvement is heterogeneous, varying from very mild and transient symptoms to extremely severe and debilitating, or even lethal syndromes. In this review, we will discuss the broad scenario of CNS complications and toxicities occurring during the treatment of pediatric patients receiving both chemotherapies and hematopoietic stem cell transplantation. Different types of complications are reviewed ranging from therapy related to cerebrovascular with a specific focus on neuroradiologic and clinical features.
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Affiliation(s)
- Duccio Maria Cordelli
- Child Neurology and Psychiatry Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Riccardo Masetti
- Department of Pediatrics, "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Daniele Zama
- Department of Pediatrics, "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Francesco Toni
- Neuroradiology Department, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Ilaria Castelli
- Department of Pediatrics, "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
| | - Emilia Ricci
- Child Neurology and Psychiatry Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Emilio Franzoni
- Child Neurology and Psychiatry Unit, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Andrea Pession
- Department of Pediatrics, "Lalla Seràgnoli", Hematology-Oncology Unit, University of Bologna, Bologna, Italy
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12
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Syed FI, Couriel DR, Frame D, Srinivasan A. Central Nervous System Complications of Hematopoietic Stem Cell Transplant. Hematol Oncol Clin North Am 2016; 30:887-98. [PMID: 27444002 DOI: 10.1016/j.hoc.2016.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hematopoietic stem cell transplantation (SCT) is now commonly used to treat several hematologic and nonhematologic diseases. Central nervous system (CNS) complications post-transplantation occur commonly in the first year and result in increased mortality from infectious, toxic, metabolic, or vascular causes. Infections secondary to aspergillus, toxoplasma and viruses cause many of the complications. Drug-related toxicities arising from conditioning regimens and graft-versus-host disease prophylaxis, as well as intraparenchymal hemorrhage, are not uncommon and can result in increased morbidity. Secondary CNS cancers have a higher incidence 5 or more years after allogeneic SCT.
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Affiliation(s)
- Faiz I Syed
- Division of Neuroradiology, Department of Radiology, VA Ann Arbor Health System, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Daniel R Couriel
- BMT Program, Huntsman Cancer Center, University of Utah, 2000 Circle of Hope. Office #2151, Salt Lake City, UT 84112, USA
| | - David Frame
- Department of Pharmacy, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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13
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Annaloro C, Costa A, Fracchiolla NS, Mometto G, Artuso S, Saporiti G, Tagliaferri E, Grifoni F, Onida F, Cortelezzi A. Severe fludarabine neurotoxicity after reduced intensity conditioning regimen to allogeneic hematopoietic stem cell transplantation: a case report. Clin Case Rep 2015; 3:650-5. [PMID: 26273463 PMCID: PMC4527817 DOI: 10.1002/ccr3.308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 04/22/2015] [Accepted: 05/13/2015] [Indexed: 12/27/2022] Open
Abstract
We present a case of severe, irreversible neurotoxicity in a 55-year-old-patient with myelofibrosis undergoing hematopoietic stem cell transplantation following a reduced intensity conditioning including fludarabine. The patient developed progressive sensory-motor, visual and consciousness disturbances, eventually leading to death. MRI imaging pattern was unique and attributable to fludarabine neurotoxicity.
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Affiliation(s)
- Claudio Annaloro
- Hematology and BMT Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy
| | - Antonella Costa
- Neuroradiology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy
| | - Nicola S Fracchiolla
- Hematology and BMT Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy
| | - Gabriella Mometto
- Hematology and BMT Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy
| | - Silvia Artuso
- Hematology and BMT Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy
| | - Giorgia Saporiti
- Hematology and BMT Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy
| | - Elena Tagliaferri
- Hematology and BMT Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy
| | - Federica Grifoni
- Hematology and BMT Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy
| | - Francesco Onida
- Hematology and BMT Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy ; Faculty of Medicine, University of Milan Milan, Italy
| | - Agostino Cortelezzi
- Hematology and BMT Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy ; Faculty of Medicine, University of Milan Milan, Italy
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Liachenko S, Ramu J, Konak T, Paule MG, Hanig J. Quantitative Assessment of MRI T2 Response to Kainic Acid Neurotoxicity in Rats in vivo. Toxicol Sci 2015; 146:183-91. [PMID: 25904105 DOI: 10.1093/toxsci/kfv083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The aim of this study was to assess quantitative changes in T2 relaxation using magnetic resonance imaging approaches in rats exposed to kainic acid to assess the utility of such endpoints as biomarkers of neurotoxicity. Quantitative T2 mapping was performed in 21 rats before and 2, 24, and 48 h after a single ip injection of 10 mg/kg of kainic acid. Three methods of quantifying T2 changes were explored: (1) Thresholding: all voxels exhibiting T2 ≤ 72 ms were designated normal tissue, whereas voxels exhibiting T2 > 72 ms were designated as lesioned tissue; (2) Statistical mapping: T2 maps obtained after treatment were statistically compared with averaged "baseline" maps, voxel-by-voxel; (3) Within-subject difference from baseline: for each individual the baseline T2 map was subtracted from the T2 map obtained after treatment. Based on the follow-up histopathological response there were 9 responders, 7 nonresponders, and 5 animals were not classified due to early sacrifice at 2 h which was too soon after treatment to detect any morphological evidence. The "thresholding" method (1) detected differences between groups only at the later time point of 48 h, the "statistical mapping" approach (2) detected differences 24 and 48 h after treatment, and the "within-subject difference from baseline" method (3) detected statistically significant differences between groups at each time point (2, 24, and 48 h). T2 mapping provides an easily quantifiable biomarker and the quantification method employing the use of the same animal as its own control provides the most sensitive metrics.
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Affiliation(s)
- Serguei Liachenko
- *Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas and Office of Testing and Research, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Jaivijay Ramu
- *Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas and Office of Testing and Research, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Tetyana Konak
- *Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas and Office of Testing and Research, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Merle G Paule
- *Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas and Office of Testing and Research, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Joseph Hanig
- *Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas and Office of Testing and Research, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
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15
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Rimkus CDM, Andrade CS, Leite CDC, McKinney AM, Lucato LT. Toxic leukoencephalopathies, including drug, medication, environmental, and radiation-induced encephalopathic syndromes. Semin Ultrasound CT MR 2014; 35:97-117. [PMID: 24745887 DOI: 10.1053/j.sult.2013.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Toxic leukoencephalopathies can be secondary to the exposure to a wide variety of exogenous agents, including cranial irradiation, chemotherapy, antiepileptic agents, drugs of abuse, and environmental toxins. There is no typical clinical picture, and patients can present with a wide array of signs and symptoms. Involvement of white matter is a key finding in this scenario, although in some circumstances other high metabolic areas of the central nervous system can also be affected. Magnetic resonance (MR) imaging usually discloses bilateral and symmetric white matter areas of hyperintense signal on T2-weighted and fluid-attenuated inversion recovery images, and signs of restricted diffusion are associated in the acute stage. In most cases, the changes are reversible, especially with prompt recognition of the disease and discontinuation of the noxious agent. Either the MR or clinical features may be similar to several nontoxic entities, such as demyelinating diseases, leukodystrophies, hepatic encephalopathy, vascular disease, hypoxic-ischemic states, and others. A high index of suspicion should be maintained whenever a patient presents recent onset of neurologic deficit, searching the risk of exposure to a neurotoxic agent. Getting to know the most frequent MR appearances and mechanisms of action of causative agents may help to make an early diagnosis and begin therapy, improving outcome. In this review, some of the most important causes of leukoencephalopathies are presented; as well as other 2 related conditions: strokelike migraine attacks after radiation therapy syndrome and reversible splenial lesions.
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Affiliation(s)
| | - Celi Santos Andrade
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Claudia da Costa Leite
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexander M McKinney
- Department of Radiology/Neuroradiology, University of Minnesota and Hennepin County Medical Centers, Minneapolis, MN
| | - Leandro Tavares Lucato
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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16
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Crombe A, Alberti N, Gilles M, Guy A, De Roquefeuil E, Dousset V, Tourdias T. Extensive acute toxic leukoencephalopathy induced by fludarabine: two months follow-up on brain MRI. J Neuroradiol 2014; 42:127-30. [PMID: 25454396 DOI: 10.1016/j.neurad.2014.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/26/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Amandine Crombe
- Department of diagnostic and therapeutic neuroimaging, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - Nicolas Alberti
- Department of radiology, Saint-André hospital, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - Marion Gilles
- Department of ophtalmology, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Alexandre Guy
- Department of hematology, Haut-Leveque hospital, 1, avenue Magellan, 33600 Pessac, France
| | - Elise De Roquefeuil
- Department of diagnostic and therapeutic neuroimaging, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Vincent Dousset
- Department of diagnostic and therapeutic neuroimaging, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Thomas Tourdias
- Department of diagnostic and therapeutic neuroimaging, Pellegrin hospital, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Peddi PF, Peddi S, Santos ES, Morgensztern D. Central nervous system toxicities of chemotherapeutic agents. Expert Rev Anticancer Ther 2014; 14:857-63. [DOI: 10.1586/14737140.2014.911089] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Helton KJ, Patay Z, Triplett BM. Fludarabine-induced severe necrotizing leukoencephalopathy in pediatric hematopoietic cell transplantation. Bone Marrow Transplant 2012; 48:729-31. [PMID: 23085831 DOI: 10.1038/bmt.2012.196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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19
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Spectrum of neurologic complications in chronic lymphocytic leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 12:164-79. [PMID: 22192500 DOI: 10.1016/j.clml.2011.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 10/19/2011] [Accepted: 10/27/2011] [Indexed: 12/21/2022]
Abstract
Neurologic disease is believed to be an unusual complication during the course of chronic lymphocytic leukemia. Nevertheless, it has already been proven in autopsy series that the incidence of occult nervous system infiltration is much higher than was previously expected. The advent of more potent drugs to treat this lymphoproliferative disorder has brought a new hope for a possible cure in the future. However, an appropriate systemic treatment for central nervous system infiltration of this disease is still lacking. Also, due to the potent immunosuppressive properties of the agents used in the up-front treatment, for example, the purine nucleoside analogues, we have witnessed an increase in the incidence of opportunistic infections, with progressive multifocal leukoencephalopathy being one of the most serious. The goal of this review is to summarize the spectrum of neurologic derangements linked to chronic lymphocytic leukemia and to raise clinicians' awareness to recognize the possibility of such associations.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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