Central nervous system graft-versus-host disease: report of two cases and literature review

Rt, Kamble; Cc, Chang; Sanchez, Steven R.; Carrum, George

doi:10.1038/sj.bmt.1705540

Cited by 76 publications

(60 citation statements)

References 15 publications

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“…In contrast, cerebral infiltration has been reported in eight long-term survivors with chronic GVHD. [8][9][10][11][12][13] The histological pattern of inflammation was consistent with our findings concerning perivascular localization of lymphomononuclear infiltrates and glial activation. Involvement of the vessel wall was present in all of our patients, whereas transmural granulomas and occurrence of giant cells, as described earlier, 10,11 could not be detected.…”

Section: Resultssupporting

confidence: 77%

“…Meningeal vessel infiltration was also observed in one patient, but meninges were not exclusively affected as reported previously. 9 In analogy with former findings, immunohistological subtyping identified the cerebral infiltrates in our patients to be monocytes and cytotoxic T cells in the majority. As in the genetic studies of Ma et al, 11 we could show that perivascular cerebral infiltrates in the brain of Patient 2 were of donor origin using the in-situ hybridization technique.…”

Section: Resultsmentioning

confidence: 69%

“…Owing to the short follow-up period, symptoms were mild and confined to the peripheral nervous system. 3 Severe angiitis-like syndromes were reported casuistically to occur in patients with chronic GVHD, but diagnosis was based either on angiography 7 or on histological analysis, [8][9][10][11][12][13] with a heterogenous spectrum of immunohistological methods used.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral angiitis in four patients with chronic GVHD

Sostak

Eigenbrod

et al. 2009

Bone Marrow Transplant

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There is growing evidence that GVHD affects the central nervous system (CNS). In this study, we describe the longterm follow-up of four allogeneic BM recipients who developed cerebral angiitis-like disease probably due to GVHD. The patients developed focal neurological signs, cognitive deficits and/or coma in association with GVHD, 2-18 years after transplantation, following reduction of immunosuppressive therapy. Magnetic resonance imaging was variable, showing generalized brain atrophy, ischemic lesions or leukoencephalopathy. Diagnosis of cerebral angiitis was confirmed by histopathological analysis of bioptic brain tissue and response to immunosuppressive therapy. By means of immunohistochemistry and immunofluorescence, perivascular lymphomononuclear cerebral infiltrates were shown to express the adhesion receptor, CD11a, and the chemokine receptor, CCR5. Our findings imply that GVHD should be considered in the differential diagnosis of noninfectious angiitis-like disease of the CNS in long-term survivors after allogeneic BMT. Infiltrating cells, in analogy to typical target organs of GVHD such as skin or liver, expressed CD11a and CCR5. These findings could be of etiopathological, diagnostic and therapeutic relevance.

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Section: Resultssupporting

confidence: 77%

Section: Resultsmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

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Cerebral angiitis in four patients with chronic GVHD

Sostak

Eigenbrod

et al. 2009

Bone Marrow Transplant

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“…Kamble et al 1 recently reported two cases of central nervous system (CNS) graft-versus-host disease (GVHD) and performed a literature review. We report a patient with hemiparesis secondary to granulomatous encephalitis that was believed to be a manifestation of GVHD.…”

mentioning

confidence: 99%

Central nervous system graft-versus-host disease presenting with granulomatous encephalitis

Kew

Macaulay

Burrell

et al. 2007

Bone Marrow Transplant

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“…11 Interestingly, brain biopsies from two patients with severe neurological impairment following allo-SCT displayed a perivascular lymphocytic infiltrate composed of donor T cells. 12 Data from animal models are also consistent with T-cellmediated reactions in the CNS. 13 Taken together, it seems likely that CNS-GVHD is a genuine entity and potentially underdiagnosed.…”

mentioning

confidence: 68%