Skip to main content

Advertisement

SpringerLink
Log in

Cerebral toxoplasmosis following etanercept treatment for idiophatic pneumonia syndrome after autologous peripheral blood progenitor cell transplantation (PBPCT)

  • Case Report
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Idiophatic pneumonia syndrome (IPS) is a term used to describe lung injury following hematopoietic stem cell transplantation (HSCT) without an infectious etiology. Diagnostic criteria include multilobar infiltrates on chest X-ray, clinical symptoms consistent with pneumonia and evidence of abnormal pulmonary physiology. The incidence after autologous transplantation is low (6%) but it has a high mortality (70–80%). Treatment with high-dose steroids has been used but the results are discouraging. Etanercept is a recombinant human soluble TNF receptor fusion protein that inhibits tumor necrosis factor α (TNFα) function. Recently, promising results have been obtained with etanercept for the treatment of acute and chronic GVHD after HSCT, but there is a little information regarding adverse effects. We report a case of IPS after autologous peripheral blood progenitor cell transplantation (PBPCT) successfully treated with etanercept. The patient developed cerebral toxoplasmosis immediately after etanercept treatment with a good outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.

Similar content being viewed by others

References

  1. Clark JG, Hansen JA, Hertz MI et al (1993) Idiophatic pneumonia syndrome after bone marrow transplantation. Am Rev Respir Med 147:1601–6

    CAS  Google Scholar 

  2. Clark JG, Madtes DK, Martin TR et al (1999) Idiophatic pneumonia after bone marrow transplantation: Cytokine activation and lipopolysaccaride amplification in the bronchoalveolar compartment. Crit Care Med 27:1800–6

    CAS  PubMed  Google Scholar 

  3. Kantrow SP, Hackman RC, Boeckh M et al (1997) Idiopathic pneumonia syndrome. Transplantation 63:1079–86

    CAS  PubMed  Google Scholar 

  4. Joyce DA, Steer JH, Abraham LJ (1997) Glucocorticoids modulation of human monocyte/macrophage function: control of TNF-alpha secretion. Inflamm Res 46:447–51

    Article  CAS  PubMed  Google Scholar 

  5. Murray KM, Dahl SL (1997) Recombinant human tumor necrosis factor receptor (p75) Fc fusion protein (TNFR: Fc) in rheumatoid arthritis. Ann Pharmacother 31:1335–8

    CAS  PubMed  Google Scholar 

  6. Chiang KY, Abhyankar S, Bridges K et al (2002) Recombinant human tumor necrosis factor receptor fusion protein as complementary treatment for chronic graft-versus-host disease. Transplantation 73:665–7

    CAS  PubMed  Google Scholar 

  7. Kantrow SP, Hackman RC, Boeckh M et al (1997) Idiopathic pneumonia syndrome. Transplantation 63:1079–86

    CAS  PubMed  Google Scholar 

  8. Bilgrami SFA, Metersky ML, McNally D et al (2001) Idiopathic pneumonia syndrome following myeloablative chemotherapy and autologous transplantation. Ann Pharmacother 35:196–201

    Article  CAS  PubMed  Google Scholar 

  9. Lee CK, Gingrich RD, Hohl RJ et al (1995) Engraftment syndrome in autologous bone marrow and peripheral stem cell transplantation. Bone Marrow Transplant 16:175–182

    Article  CAS  PubMed  Google Scholar 

  10. Ravoet C, Feremans W, Husson B et al (1996) Clinical evidence for an engraftment syndrome associated with early and steep neutrophil recovery after autologous blood stem cell transplantation. Bone Marrow Transplant 18:943–947

    CAS  PubMed  Google Scholar 

  11. Madero L, Vicent MG, Sevilla J et al (2002) Engraftment syndrome in children undergoing autologous peripheral blood progenitor cell transplantation. Bone Marrow Transplant 30:355–358

    Article  CAS  PubMed  Google Scholar 

  12. Miyazaki Y, Araki K, Vesin C et al (1995) Expression of a tumor necrosis factor α transgene in murine lung causes lymphocytic and fibrosing alveolitis. J Clin Invest 96:250–259

    CAS  PubMed  Google Scholar 

  13. Piemonti L, Monti P, Allavena P et al (1999) Glucocorticoids affect human dendritic cell differentiation and maturation. J Immunol 162:6473–6481

    CAS  PubMed  Google Scholar 

  14. Suffredini AF, Reda D, Banks SM et al (1995) Effects of recombinant dimeric TNF receptor on human inflammatory responses following intravenous endotoxin administration. J Immunol 155:5038–5045

    CAS  PubMed  Google Scholar 

  15. Bathon JM, Martin RW, Fleischmann RM et al (2000) A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med 343:1586–1593

    CAS  PubMed  Google Scholar 

  16. Henter JI, Karlen J, Calming U et al (2001) Successful treatment of Langerhans-cell histiocytosis with etanercept. N Engl J Med 345:1577–1578

    CAS  Google Scholar 

  17. Steensma DP, Mesa RA, Li CY et al (2002) Etanercept, a soluble tumor necrosis factor receptor, palliates constitutional symptoms in patients with myelofibrosis with myeloid metaplasia: results of a pilot study. Blood 99:2252–2254

    Article  CAS  PubMed  Google Scholar 

  18. Maciejewski JP, Risitano AM, Sloand EM et al (2002) A pilot study of the recombinant soluble human tumour necrosis factor receptor (p75)-Fc fusion protein in patients with myelodysplastic syndrome. Br J Haematol 117:119–126

    CAS  PubMed  Google Scholar 

  19. Prahalad S, Bove KE, Dickens D et al (2001) Etanercept in the treatment of Macrophage Activation Syndrome.J Rheumatol 28:2120–2124

    Google Scholar 

  20. Yanik G, Hellerstedt B, Custer J et al (2002) Etanercept (Enbrel) administration for idiophatic pneumonia syndrome after allogeneic Hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 8:395–400

    CAS  PubMed  Google Scholar 

  21. Pasparakis M, Alexopoulou L, Episkopou V et al (1996) Immune and inflammatory responses in TNF alpha-deficient mice: a critical requirement for TNF alpha in the formation of primary B cell follicles, follicular dendritic cell networks and germinal centers, and in the maturation of the humoral immune response. J Exp Med 184:1397–1411

    CAS  PubMed  Google Scholar 

  22. Marino MW, Dunn A, Grail D et al (1997) Characterization of tumor necrosis factor-deficient mice. Proc Nat Acad Science 94:8093–8098

    Article  CAS  Google Scholar 

  23. Moreland LW, Bucy RP, Weinblatt ME et al (2002) Immune function in patients with rheumatoid arthritis treated with etanercept. Clin Immunol 103:13–21

    Article  CAS  PubMed  Google Scholar 

  24. Phillips K, Husni ME, Karlson EW et al (2002) Experience with etanercept in an academic medical center: are infection rates increased? Arthritis Care and Research 47:17–21

    Article  CAS  PubMed  Google Scholar 

  25. Johnson LL (1992) A protective role for endogenous tumor necrosis factor in Toxoplasma gondii infection. Infect Immun 60:1979–1983

    CAS  PubMed  Google Scholar 

  26. Gazzinelli RT, Eltoum I, Wynn TA et al (1993) Acute cerebral toxoplasmosis is induced by in vivo neutralization of TNF-alpha and correlates with the down-regulated expression of inducible nitric oxide synthase and other markers of macrophage activation. J Immunol 151:3672–3681

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Bone Marrow Unit, Department of Pediatric Hematology and Oncology, Niño Jesús Children's Hospital, Avda. Menéndez Pelayo nº65, 28009, Madrid, Spain

    M. Gonzalez-Vicent, M. A. Diaz, J. Sevilla & L. Madero

Authors
  1. M. Gonzalez-Vicent
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. A. Diaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Sevilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Madero
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Gonzalez-Vicent.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gonzalez-Vicent, M., Diaz, M.A., Sevilla, J. et al. Cerebral toxoplasmosis following etanercept treatment for idiophatic pneumonia syndrome after autologous peripheral blood progenitor cell transplantation (PBPCT). Ann Hematol 82, 649–653 (2003). https://doi.org/10.1007/s00277-003-0705-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-003-0705-2

Keywords

Search

Navigation