Neurological complications in adult allogeneic hematopoietic stem cell transplant patients: Incidence, characteristics and long-term follow-up in a multicenter series

Wieczorek, Michele; Mariotto, Sara; Ferrari, Sérgio; Mosna, Federico; Micò, Maria Caterina; Borghero, Carlo; Dubbini, Maria Vittoria; Malagola, Michele; Skert, Cristina; Andreini, Angelo; Marco, Beatrice De; Polo, Diana; Tfaily, Ahmad; Krampera, Mauro; Grassi, Anna; Candoni, Anna; Ranzato, Federica; Volonghi, Irene; Quatrale, R.; Benedetti, Fabio; Tecchio, Cristina

doi:10.1038/s41409-022-01690-x

Cited by 5 publications

(5 citation statements)

References 38 publications

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“…CNS complications represent a diagnostic and clinical challenge in HM patients, particularly in allo-HSCT recipients, where infections account for approximately 30% of CNS complications, primarily due to IFD, toxoplasmosis, and herpes virus encephalitis. The overall mortality rate, due to CNS complications, is considerable, ranging from 20% to 25%, with infections being the leading cause of mortality related to CNS complications [24].…”

Section: Case Discussion and Literature Reviewmentioning

confidence: 99%

Cerebral Infectious Opportunistic Lesions in a Patient with Acute Myeloid Leukaemia: The Challenge of Diagnosis and Clinical Management

Cavazza,

Motto,

Regna-Gladin

et al. 2024

Antibiotics

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Central nervous system (CNS) lesions, especially invasive fungal diseases (IFDs), in immunocompromised patients pose a great challenge in diagnosis and treatment. We report the case of a 48-year-old man with acute myeloid leukaemia and probable pulmonary aspergillosis, who developed hyposthenia of the left upper limb, after achieving leukaemia remission and while on voriconazole. Magnetic resonance imaging (MRI) showed oedematous CNS lesions with a haemorrhagic component in the right hemisphere with lepto-meningitis. After 2 weeks of antibiotics and amphotericin-B, brain biopsy revealed chronic inflammation with abscess and necrosis, while cultures were negative. Clinical recovery was attained, he was discharged on isavuconazole and allogeneic transplant was postponed, introducing azacitidine as a maintenance therapy. After initial improvement, MRI worsened; brain biopsy was repeated, showing similar histology; and 16S metagenomics sequencing analysis was positive (Veilonella, Pseudomonas). Despite 1 month of meropenem, MRI did not improve. The computer tomography and PET scan excluded extra-cranial infectious–inflammatory sites, and auto-immune genesis (sarcoidosis, histiocytosis, CNS vasculitis) was deemed unlikely due to the histological findings and unilateral lesions. We hypothesised possible IFD with peri-lesion inflammation and methyl-prednisolone was successfully introduced. Steroid tapering is ongoing and isavuconazole discontinuation is planned with close follow-up. In conclusion, the management of CNS complications in immunocompromised patients needs an interdisciplinary approach.

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Section: Case Discussion and Literature Reviewmentioning

confidence: 99%

Cerebral Infectious Opportunistic Lesions in a Patient with Acute Myeloid Leukaemia: The Challenge of Diagnosis and Clinical Management

Cavazza,

Motto,

Regna-Gladin

et al. 2024

Antibiotics

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“…Neurological complications after allo-HSCT can be classified according to etiology or clinical presentation as listed in Table 2 [ 3 ]. The etiology of LE could be divided in infectious and non-infectious causes, where the former often has been related to HHV-6 reactivation [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our patient responded to corticosteroid and immunoglobulin therapy, although it had to repeated. We suggest that a rapid and circumstantiated diagnosis of autoimmune encephalitis, herein limbic encephalitis, could anticipate specific treatments and influence the rate or the extent of long-term disabilities [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Table 2 [3]. e etiology of LE could be divided in infectious and non-infectious causes, where the former often has been related to HHV-6 reactivation [9].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, neurological complications are rare, but a dreaded complication of allo-HSCT [ 2 ]. Reports support that a persistent neurological impairment occurs in many of those patients who suffer from neurological complications after allo-HSCT [ 3 ]. Herein, we present a patient who developed a serious neurological complication after allo-HSCT.…”

Section: Introductionmentioning

confidence: 99%

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Limbic Encephalitis following Allogeneic Hematopoietic Stem Cell Transplantation

Johansen

Kråkenes

Vedeler

et al. 2022

Case Reports in Immunology

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A woman with myelodysplastic syndrome (MDS) was treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). 65 days after the transplantation, she developed fatigue and central neurological symptoms. Clinical workup including magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination revealed findings suspicious for limbic encephalitis (LE), successfully treated with intravenous immunoglobulins and intravenous corticosteroids. Although a rare complication after allo-HSCT, physicians should be aware of neurological symptoms that develop throughout the transplantation course.

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Busulfan/prednisone/tacrolimus

2022

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Neurological complications in adult allogeneic hematopoietic stem cell transplant patients: Incidence, characteristics and long-term follow-up in a multicenter series

Cited by 5 publications

References 38 publications

Cerebral Infectious Opportunistic Lesions in a Patient with Acute Myeloid Leukaemia: The Challenge of Diagnosis and Clinical Management

Cerebral Infectious Opportunistic Lesions in a Patient with Acute Myeloid Leukaemia: The Challenge of Diagnosis and Clinical Management

Limbic Encephalitis following Allogeneic Hematopoietic Stem Cell Transplantation

Busulfan/prednisone/tacrolimus

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