Intracranial hemorrhage following bone marrow transplantation: an autopsy study of 58 patients

Abstract

Summary:Autopsy files of 180 patients were reviewed, who died after BMT between July 1987 and June 1998 and 58 (32.2%) cases, who had experienced intracranial hemorrhage (ICH) were selected. Age, sex, underlying disease, preparatory regimens, immunoprophylaxis, chronic and acute GVHD, survival of the patients and localization and size of hemorrhages were evaluated. There were 33 males and 25 females, with a mean age of 23.4 years. The main underlying disorders for which BMT was performed included SAA (n = 21), CML (n = 13) and AML (n = 10). Forty patients were found to have intraparenchymal hemorrhage, 35 had subarachnoid hemorrhage and eight patients had subdural hemorrhage. In 16 cases the CNS hemorrhage was so extensive that it was considered to be the main cause of death. There was no significant statistical difference concerning sex (P = 0.217), age (P = 0.296), underlying disease (P = 0.352), preparatory regimens (P = 0.07), immunoprophylaxis (P = 0.914), chronic and acute graft-versus-host disease (P = 0.107 and P = 0.631, respectively) and survival (P = 0.701) when comparing patients with or without ICH. However, the number of cases in which the CNS was defined as the main cause of death was higher among patients with ICH than in patients without ICH (n = 16 vs 15) (P = 0.011). We conclude that ICH is common and has a significant mortality rate following BMT. Bone Marrow Transplantation (2002) 29, 29-32. DOI: 10.1038/sj/bmt/1703315 Keywords: bone marrow transplantation; central nervous system; cerebrovascular diseases; hemorrhage Bone marrow transplantation (BMT) has significantly contributed to the therapy of life-threatening hematological and non-hematological disorders. However, the central nervous

Neurological complications of hematopoietic stem cell transplantation (HSCT): a retrospective study in a HSCT center in Brazil

“…In 2002 Bleggi-torres et al examined the results of 58 autopsies of patients who had received hsct and had developed intracranial hemorrhage 18 . the authors reported that 40 patients had intracerebral hemorrhage, 35 subarachnoid hemorrhage and eight subdural hemorrhage 14 . In 16 cases bleeding was extensive and directly related to death 14 .…”

“…the authors reported that 40 patients had intracerebral hemorrhage, 35 subarachnoid hemorrhage and eight subdural hemorrhage 14 . In 16 cases bleeding was extensive and directly related to death 14 .…”

Maintaining high autopsy rates in a Canadian blood and marrow transplant program: preserving a diagnostic and research tool

“…Nevertheless, specialized clinical programs, such as hematopoietic stem cell transplantation (HSCT), are evolving rapidly and rely on strict quality control and feedback mechanisms to improve clinical outcomes. Moreover, autopsy series have been instructive in understanding patterns of graft-versushost disease (GVHD), 9 as well as infectious, 10 and toxic complications [11][12][13] of HSCT. Rates of post-mortem exams at bone marrow transplant centers, however, have not been specifically documented.…”

CT and MR imaging of central nervous system effects of therapy in patients treated for hematological malignancies

“…Intracranial bleeding has also been reported in children treated with radiation therapy [2]. Hemorrhage may occur in a variety of locations, i.e., subdural, subarachnoid, and intracerebral [23]. Almost one-fifth of patients have more than one type of hemorrhage.…”

“…Prolonged thrombocytopenia leads to catastrophic and fatal cerebral hemorrhage [22,23]. It can be explained by a chemotherapy or radiation-induced decrease in megakaryocytes, or alternatively by immunological (autoimmune) or drug-induced mechanisms of platelet destruction or dysfunction, particularly L-asparaginase.…”