Clinical characteristics of calcineurin inhibitor-induced pain syndrome (CIPS) after allogeneic hematopoietic stem cell transplantation

Noriko Doki; Kazuhiko Kakihana; Masahiro Ashizawa; Masahiro Onoda; Chikako Ohwada; Sumiko Kobayashi; Moritaka Gotoh; Shin Fujisawa; Shinichiro Okamoto; for the Kanto Study Group for Cell Therapy

doi:10.7889/hct.6.115

Original Article

Clinical characteristics of calcineurin inhibitor-induced pain syndrome (CIPS) after allogeneic hematopoietic stem cell transplantation

Noriko Doki, Kazuhiko Kakihana, Masahiro Ashizawa, Masahiro Onoda, Chikako Ohwada, Sumiko Kobayashi, Moritaka Gotoh, Shin Fujisawa, Shinichiro Okamoto, for the Kanto Study Group for Cell Therapy

Author information

Noriko Doki
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Kazuhiko Kakihana
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Masahiro Ashizawa
Division of Hematology, Jichi Medical University, Saitama Medical Center, Omiya, Japan
Masahiro Onoda
Internal medicine, Chiba Aoba Municipal Hospital, Chiba, Japan
Chikako Ohwada
Department of Hematology, Chiba University Hospital, Chiba, Japan
Sumiko Kobayashi
Department of Hematology, Tokyo Metropolitan Gerontology Hospital, Tokyo, Japan
Moritaka Gotoh
Department of Hematology, Tokyo Medical University, Tokyo, Japan
Shin Fujisawa
Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
Shinichiro Okamoto
Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
for the Kanto Study Group for Cell Therapy

Keywords: Calcineurin-inhibitor induced pain syndrome (CIPS), allogeneic hematopoietic stem cell transplantation (allo-HSCT), leg pain, pruritus, human herpesvirus-6 (HHV-6)

JOURNAL FREE ACCESS

2017 Volume 6 Issue 2 Pages 115-119

DOI https://doi.org/10.7889/hct.6.115

Details

Abstract

Calcineurin inhibitor (CI)-induced pain syndrome (CIPS) is a rare complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, because of its rarity, the optimal management of this complication remains unknown.

We analyzed the clinical features and treatment outcomes of the patients who developed CIPS after allo-HSCT. The study included patients who underwent allo-HSCT between January 2003 and December 2014 at the hospitals participating in the KSGCT. Sixteen patients developed CIPS. The most common symptom was leg pain, which was observed in 9 patients, followed by leg pain associated with pruritus in five, and pruritus only in two. The median time from allo-HSCT to CIPS was 16 days. CIPS occurred within 30 days of starting CIs in 14 patients (87.5%). CI was discontinued in four patients; the dose of CI was reduced in two patients, and seven patients were switched to another CI. The symptoms in all of those 13 patients with intervention resolved within 6 days from the onset of CIPS.

The possibility of CIPS must be considered when patients who have undergone allo-HSCT develop intolerable leg pain and/or pruritus. Our findings suggest that withdrawal/dose reduction of the CI or substitution with another CI is an effective treatment for CIPS.

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