Severe neurologic complications after hematopoietic stem cell transplantation in children

Abstract

Severe neurologic complications are frequent (14%) among children receiving HSCT, causing 8.5% of deaths after transplant. Transplant from allogeneic donor, especially if unrelated, the development of severe acute GvHD grade >2, and the use of TBI in the preparative regimen are the main risk factors for such complications.

Reversible posterior leukoencephalopathy syndrome complicating cytotoxic chemotherapy for hematologic malignancies

“…RPLS is most commonly seen in patients with hypertensive encephalopathy, eclampsia, renal failure, or use of cyclosporine or tacrolimus [13]. Despite increasing awareness of RPLS as a complication of treatment of childhood cancers [8,22,24,25], this syndrome is rarely reported in the adult oncology setting. We report two patients who developed RPLS during cytotoxic chemotherapy for hematological malignancies.…”

Mesial temporal sclerosis – a late complication in four allogeneic pediatric recipients with persistent seizures after an acute episode of cyclosporine-A neurotoxicity

“…Magnetic resonance imaging (MRI) obtained in patients with acute CSA neurotoxicity usually shows posterior reversible encephalopathy syndrome (PRES), gray and white matter focal changes, vascular injury in watershed areas, or central pontine myelinolysis. [1][2][3] Nevertheless, few cases with persistent epilepsy after CSA discontinuation have been reported. 2 We reviewed the clinical records and neuroimaging results of four pediatric hematopoietic stem cell transplantation (HSCT) recipients treated at the G Gaslini Children's Research Institute, who developed recurrent partial intractable seizures after having experienced a previous episode of CSA neurotoxicity.…”

Non-endocrine late complications in children after allogeneic haematopoietic SCT

“…18,49 Patients affected by predisposing conditions (neurotoxic treatment given in first-line therapy, CSA neurotoxicity, anoxic injury) may develop mesial temporal sclerosis with clinical finding of temporal intractable epilepsy. 52 Leukoencephalopathy, mineralizing microangiopathy, necrotizing leukoencephalopathy and brain atrophy 5,18,53 are diagnosed by magnetic resonance imaging of the brain. Hearing abnormalities and incidence of ototoxicity are increased in patients who are treated with cyclophosphamide, thiotepa, cisplatin and carboplatin either as a part of the chemotherapy or the conditioning regimen before HSCT.…”