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Neurologic complications after high-dose chemotherapy and autologous bone marrow transplantation for Hodgkin's disease

Sections of Neurology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE (Drs. Bashir and Snider)
Oncology/Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE (Dr. Bierman).

We analyzed 168 consecutive patients with Hodgkin's disease who were treated at the University of Nebraska Medical Center between 1985 and 1990 with high-dose chemotherapy followed by autologous bone marrow transplantation (BMT) or peripheral stem-cell transplantation (PSCT), and describe their neurologic complications. All these patients had relapsed or had failed to achieve a remission with initial chemotherapy. Early complications, defined as those occurring during the first 6 weeks following the transplantation, occurred in 65 patients (39%) and included encephalopathy, seizures, psychiatric symptoms, and cerebral hemorrhage; these were mild and reversible in 47 and fatal in 18 patients. The major cause of these early neurologic complications was pulmonary failure. Late neurologic complications, defined as those occurring 6 weeks after the BMT or PSCT was performed, occurred in 21% of patients and included encephalopathy, peripheral neuropathy, cerebral hemorrhage, and spinal cord compression. Serious nervous system complications following autologous BMT or PSCT for Hodgkin's disease are less frequent than those following allogeneic BMT and are usually a result of injury to other organ systems.

Address correspondence and reprint requests t o Dr. Rifaat Bashir, Section Chief, Division of Neurology, University of Nebraska Medical Center, 600 South 42nd Street, Omaha, NE 68198-2045.

Received June 7, 1993. Accepted for publication in final form September 24, 1993.

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