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

Abstract

-We present the neurological complications evaluated in a series of 1000 patients who underwent hematopoietic stem cell transplantation (hsct). central nervous system (cNs) neurological complications, particularly brain hemorrhages, were the most common, followed by seizures and cNs infections. An unusual neurological complication was Wernicke's encephalopathy. Less frequent neurological complications were metabolic encephalopathy, neuroleptic malignant syndrome, reversible posterior leukoencephalopathy syndrome, brain infarct and movement disorders. the most common neurological complication of the peripheral nervous system was herpes zoster radiculopathy, while peripheral neuropathies, inflammatory myopathy and myotonia were very rarely found.KEY WORDs: neurological complications, hematopoietic stem cell transplantation, stem-cell transplantation. Complicações neurológicas do transplante de células tronco hematopoiéticas (TCTH): estudo retrospectivo em um centro de TCTH no BrasilResumo -Apresentamos as complicações neurológicas avaliadas em uma série de 1000 pacientes submetidos ao transplante de células tronco hematopoiéticas (tcth). As complicações neurológicas do sistema nervoso central foram as mais encontradas, particularmente as hemorragias encefálicas, seguidas por crises convulsivas e por infecções. Uma complicação peculiar foi a encefalopatia de Wernicke. Menos freqüentemente foram encontrados casos de encefalopatia metabólica, síndrome maligna neuroléptica, leucoencefalopatia posterior reversível, infarto cerebral e os distúrbios do movimento. Entre as complicações neurológicas do sistema nervoso periférico a mais encontrada foi a radiculopatia pelo herpes zoster, enquanto que raramente se observaram casos de polineuropatias periféricas, miopatia inflamatória e de miotonia.PALAvRAs-chAvE: complicações neurológicas, transplante de células tronco hematopoiéticas, transplante de precursores hematopoiéticos.

Central Nervous System Complications and Outcomes After Allogeneic Hematopoietic Stem Cell Transplantation

“…Previous studies have shown a similar incidence of 8% to 18% during first 100 days. 6,7,[15][16][17][18][19][20] Two-thirds of CNSC occurred during the first 100 days after transplantation, which is in accordance with the results of prior studies. 6,15 This highlights that the highest risk of CNSC is during the early period after allo-HSCT.…”

“…The commonly reported CNSC in previous studies include PRES, stroke, seizure, metabolic encephalopathy, drug-induced toxicity, and infection. 6,7,[15][16][17][18][19][20] Surprisingly, patients who were transplanted between the years 2009 and 2011 seemed to develop more CNSC compared to prior years. Although there was no obvious identifiable factor, we speculate that such a trend is related to differences in the patient population in recent years.…”

“…7,14 Furthermore, CNSC can contribute to the increased mortality and thus compromise long-term outcome of allo-HSCT. 6,7,[15][16][17][18][19][20] There is a relative paucity of literature on CNSC of allo-HSCT, and importantly, previous studies differ in terms of the definition of CNSC, age group of study population, and other characteristics. 6,7,[15][16][17][18][19][20] In this retrospective analysis of allo-HSCT done at University of Nebraska Medical Center (UNMC), we studied the incidence of CNSC, its identifiable risk factors, and its impact on survival.…”

Neurologic Complications after Allogeneic Hematopoietic Stem Cell Transplantation in Children: Analysis of Prognostic Factors

“…In the literature, the incidence of neurologic complications was reported with a range from 9.7% to 65%. This wide range may be due to the heterogeneity of study populations and extensive variation in definitions of neurologic complications [4,[6][7][8][9][10][11][12][13][14]. If the severity was confined to clinically significant neurologic complications (CTCAE grade 3 and above, or possibly assumed), the incidence ranges from 9.7% to 23% at around 6 to 12 months after HSCT [4,6,7,9,12].…”

“…Neurologic symptoms based on depressed level of consciousness or pyramidal tract dysfunction, weakness, and sensory, behavior, and speech impairment were regarded as neurologic events. Based on previous studies on neurologic complications after allogeneic HSCT, the etiologies of the neurologic complications were classified into the following 7 groups [3,7,13,14]: (1) calcineurin inhibitor (CNI)erelated neurotoxicity, which presented as posterior reversible encephalopathy syndrome (PRES) and/or toxic encephalopathy with symmetrically reduced diffusion in the periventricular and supraventricular white matter in brain magnetic resonance imaging diffusion findings without any definite etiologies; (2) infectious diseases, defined by the detection of pathogens in cerebrospinal fluid upon a culture and/or polymerase chain reaction (PCR). In case of fungal infection, we used revised definition of European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group [15,16];…”