Life-threatening neurological complications after bone marrow transplantation in children

Abstract

Summary:Neurological complications may occur in BMT recipients (11-59%), frequently contributing to morbidity or mortality. They are the main causes of death in 10-15%. Lifethreatening neurological complications were seen in 11 out of 113 (9.7%) children who underwent BMT from HLAmatched family (n ¼ 7) or mismatched donors (n ¼ 4) at our institution. Diagnoses of patients with neurological complications were acute myeloblastic leukemia (AML) (five), thalassemia major (two), Fanconi anemia (two), Omenn syndrome (one) and leukodystrophy (one), and the neurological events were seen between days þ 13 and þ 85 after transplantation. Minor symptoms including reversible, nonrepetitive seizures were excluded. Cyclosporine A toxicity was diagnosed in six children. The rest of the complications were brain abscess/meningoencephalitis (two), severe hypomagnesemia (one), busulfan toxicity (one), sustained hypertension (three), and intracranial hemorrhage (three). Six patients with neurological complications suffered from 4grade II graft-versus-host disease (GvHD), and all were high risk for transplantrelated complications. In this study, risk status of the underlying disease, mismatched transplantation, a diagnosis of AML (advanced stage), older age and 4grade II GvHD were important adverse factors for the development of severe life-threatening neurological complications. Bone Marrow Transplantation (2005) 35, 71-76.

Factors Influencing the Outcome of Hematopoietic Stem Cell Transplantation in Pediatric Acute Myeloid Leukemia: Single Institution Results from Saudi Arabia

“…Chinese also came up with a similar result and also noticed a lower incidence of chronic GVHD in cord blood donor transplant compare to unrelated donor and with a similar outcome with a suitable sibling [38]. Post-HCT toxicity is a cause of concern in most transplant centers and is highlighted in various studies [39]. In our cohort,three patients acquired CMV infection after transplant and no one developed VOD, Haemorrhagic cystitis or other major complications, which could be the due to optimally matched donors and a good post HCT nursing support [40][41][42][43][44].…”

Diagnostic and therapeutic implications of neurological complications following paediatric haematopoietic stem cell transplantation

“…These findings are in accordance with previous clinical studies, which showed that neurological complications are seen more frequently in allogeneic, especially mismatched, transplantations 3,4 particularly in patients with grade II-IV GvHD. 2 However, there is a marked variability of incidence rate among the different published studies, ranging from 11% in clinical series up to 90% in autopsy studies. Only a few studies were undertaken in the paediatric age group.…”

“…5 Mismatched related or unrelated donor allogeneic transplantation and the occurrence of GvHD were the most significant risk factors for development of neurological complications, most probably related to pronounced immunosuppression in such patients. [2][3][4] The wide range of incidence rate of neurological symptoms reported in the previous studies may be in part attributable to different classifications used, heterogeneous study populations, risk profiles and follow-up periods. Therefore, comparability among these studies is limited and very few data are available in the paediatric population.…”

“…1 Central nervous system (CNS) complications are considered an important cause of morbidity and significantly contribute to mortality after SCT. [2][3][4][5] Previous clinical studies reported neurological abnormalities in 11-59% of patients after SCT. 2,3,6 However, in autopsy studies neuropathological abnormalities were found in more than 90% of patients who died after SCT.…”

Neurological Complications of Transplantation

“…[9][10][11] The reported frequency and type of complications varies depending on case ascertainment definition and population examined. [12][13][14][15] In most studies, participants receiving allogeneic HCT are reported to have a higher risk of neurological complications compared to autologous HCT participants. However, one large retrospective study found the incidence similar but the frequency and distribution of complications varied.…”