Neurological and neuroradiological findings in long‐term survivors of allogeneic bone marrow transplantation

Padovan, Claudio S.; Yousry, Tarek; Schleuning, Michael; Holler, Ernst; Kolb, Hans‐Jochem; Straube, Andreas

doi:10.1002/ana.410430511

Cited by 80 publications

(63 citation statements)

References 30 publications

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“…We have retrospectively observed neurological deficits, cognitive impairment and magnetic resonance imaging (MRI) abnormalities in more than 50% of long-term survivors after allo-BMT in association with chronic GVHD. 6 A prospective study within the first year after transplantation confirmed a similar high rate of GVHD-related neurological abnormalities. Owing to the short follow-up period, symptoms were mild and confined to the peripheral nervous system.…”

Section: Introductionmentioning

confidence: 72%

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: Introductionmentioning

confidence: 72%

Cerebral angiitis in four patients with chronic GVHD

Sostak

Eigenbrod

et al. 2009

Bone Marrow Transplant

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“…2,3 In contrast to these studies with a short mean survival time after BMT, in a previous study we found an association of clinical and MRI abnormalities with chronic GVH disease in long-term BMT survivors. 7 Until now, the apparent rarity of confirmed brain GVHD has remained unclear, possibly because brain involvement during GVH disease might take longer to develop and mild CNS GVH disease might not be diagnosed properly or is clinically asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…These findings support our previous hypothesis that cerebral involvement occurs during GVH disease. 7 Cerebral angiitis, which may be a particular neurological manifestation of GVH disease, should be considered as a cause of cerebral ischemic or hemorrhagic episodes and pathological MRI scans in BMT patients with chronic GVH disease. Important differential diagnoses are CNS infection, multiple emboli, or cyclosporine neurotoxicity.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] Despite the large and growing number of long-term survivors of BMT, there is only limited information about late neurological complications. 6,7 Neurological involvement in chronic graft versus host (GVH) disease has until now been restricted to myasthenia gravis, polymyositis, and polyneuropathy. 8 -10 We describe a patient with chronic GVH disease who had neuropathologically confirmed cerebral angiitis.…”

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confidence: 99%

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Angiitis of the Central Nervous System After Allogeneic Bone Marrow Transplantation?

Padovan

Bise

Hahn

et al. 1999

Stroke

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Background and Purpose-There is only limited information about late neurological complications after bone marrow transplantation (BMT). The purpose of this study is to describe a cerebral angiitis-like syndrome after allogeneic BMT. Methods-Clinical and diagnostic findings of 5 BMT patients with chronic graft versus host disease and neuropathological data of 1 patient were reported. Results-In the described patients, focal neurological signs and neuropsychological abnormalities occurred years after BMT. MRI revealed periventricular white matter lesions, lacunar or territorial infarctions, leukoencephalopathy, and hemorrhages. Angiitis of the central nervous system was confirmed in 1 patient at autopsy, and an angiitis-like syndrome was suspected in the other patients because of the clinical course and response to treatment. Three patients received cyclophosphamide and steroids (2 improved, 1 died), 1 patient improved after steroids alone, and 1 patient without immunosuppressive therapy deteriorated further. Conclusions--We propose that an angiitis-like syndrome of the central nervous system can be a neurological manifestation of graft versus host disease, which should be considered a possible cause of cerebral ischemic episodes and pathological MRI scans in BMT patients with graft versus host disease. (Stroke. 1999;30:1651-1656.)

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“…Among these complications strokes (often haemorrhagic) and CNS infections are frequently severe and contribute significantly to treatment-related mortality. 1,2 Cerebral venous sinus thrombosis has rarely been reported following allogeneic bone marrow transplantation. 3 The diagnosis of this condition often requires the Correspondence: Dr CJ Harvey at his current address: Department of Imaging, Hammersmith Hospital, Du Cane Rd, London W12 ONN, UK Recceived 8 July 1999; accepted 10 December 1999 use of MRA.…”

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confidence: 99%

MR angiographic diagnosis of cerebral venous sinus thrombosis following allogeneic bone marrow transplantation

Harvey

Peniket

Miszkiel

et al. 2000

Bone Marrow Transplant

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Summary:Allogeneic bone marrow transplantation is frequently associated with neurological complications, particularly intracerebral bleeds and infections. Cerebral venous sinus thrombosis has only rarely been reported following allogeneic transplants. We report three cases of cortical venous thrombosis following allografting for acute lymphoblastic leukaemia. Two patients received marrow from HLA-identical siblings and one from an unrelated donor. Two of the patients presented with grand mal seizures and one presented with a headache. No neurological abnormalities were found upon clinical examination and lumbar puncture was normal in all three cases. In two of the patients computed tomography (CT) of the brain was normal and in the third showed non-specific abnormalities. Magnetic resonance imaging (MRI) with MR angiography (MRA) demonstrated cerebral venous sinus thrombosis in all three patients. In conclusion, cerebral venous sinus thrombosis should be considered in the differential diagnosis when neurological symptoms occur following allogeneic bone marrow transplantation. We therefore advocate the use of MRA for unexplained neurological symptoms post-allograft since without it cerebral venous sinus thrombosis may easily be missed. Bone Marrow Transplantation (2000) 25, 791-795.

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Neurological and neuroradiological findings in long‐term survivors of allogeneic bone marrow transplantation

Cited by 80 publications

References 30 publications

Cerebral angiitis in four patients with chronic GVHD

Cerebral angiitis in four patients with chronic GVHD

Angiitis of the Central Nervous System After Allogeneic Bone Marrow Transplantation?

MR angiographic diagnosis of cerebral venous sinus thrombosis following allogeneic bone marrow transplantation

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