Noninfectious neurologic complications of hematopoietic cell transplantation

Abstract

Objective/Background: Neurological complications occur at a high frequency after hematopoietic cell transplantation (HCT). However, an absence is noted in the published literature as regards the quantification of the exact burden and the outcomes thereof. In this systematic review, we endeavored to detail if the recipients of HCT developed any noninfectious neurological events/complications. Methods: According to the PICO criteria, medical literature was searched. Complications that were evaluated included: stroke, peripheral neuropathy, myasthenia gravis, seizures, and posterior reversible encephalopathy syndrome. After strictly defining relevant variables and parameters, data from 173 eligible articles were then extracted accordingly, from the full text for each, for quantitative analysis; additionally, two American Society of Hematology conference abstracts were also subject to data extraction. Results: As is evident from the results of the data analysis, an increased frequency of these complications was seen in the HCT recipient population in comparison to the general population. The relative risk ranged from 1.33× to 142× depending on the complication studied. Conclusion: These findings demonstrate that the recipients of HCT had a significantly higher risk of neurological complications and that their early recognition can enhance the monitoring of HCT survivors for the early developmental signs of neurological toxicity. This would facilitate timely interventions, thus ensuring a better quality of life.

Cerebrovascular manifestations in hematological diseases: an update

“…PRES (4.29%) and stroke (3.78%) are among the commonest neurological complications after allogenic hematopoietic stem cell transplantation for the curative treatment of malignant hematological disorders. The risk of stroke is 15 × higher than in the general population [ 87 ]. Three recent series [ 88 – 90 ] found low frequencies of both of PRES (4%) and stroke (< 1% in the first 100 days [ 79 ] to 10% in longer follow-up).…”

“…Stroke is associated with reduced survival. Mortality is high when the intracerebral hemorrhage is associated with severe thrombocytopenia [ 87 ]. Most of the cases of PRES are due to the administration of a calcineurin Inhibitor (cyclosporine, tacrolimus).…”

“…Most of the cases of PRES are due to the administration of a calcineurin Inhibitor (cyclosporine, tacrolimus). PRES has a lower occurrence in the auto-transplant population (0.86%) [ 87 ].…”

Association of graft-versus-host-disease with neurologic complications: clinical paradigm and future directions

“…aGVHD and cGVHD is prevalent amongst HCT recipients, with notable differences in frequencies amongst patients experiencing each NC studied [5]. The complex association of GVHD within the pathophysiologic framework of the NCs listed above has been described in the literature.…”

Acute Graft-Versus-Host Disease, Infections, Vascular Events and Drug Toxicities Affecting the Central Nervous System

“…There is increasing evidence that the effects of acute GVHD are not limited to the three classical target organs, but can also occur in the central nervous system (CNS). Neurological complications were reported in 10% of the patients undergoing autologous (auto)-HCT while over 80% of allo-HCT patients experienced neurological complications at some time point ( 10 – 12 ) which indicates that not only the toxicity but also the allo-reactive effect of the donor immune system may contribute to neurological complications. Clinical manifestations of CNS-GVHD include seizures, reduced vision and cognitive impairment.…”