Early neurologic complications following allogeneic bone marrow transplant for leukemia
A prospective study
Abstract
Background: Bone marrow transplant (BMT) is used for both neoplastic and nonneoplastic diseases. Following BMT, particularly during the first 3 months, patients have a number of neurologic complications. We evaluated the early neurologic complications following BMT and their influence on survival.
Methods: We prospectively followed 115 consecutive patients having BMT for leukemia, for a median period of 90 days after transplantation.
Results: Sixty-four patients (56%) had neurologic complications. Sixteen developed more than one complication. Twenty-seven patients (25%) had major neurologic complications: metabolic encephalopathy (8), seizures (8), psychiatric symptoms (3), cerebral hemorrhage (1), cerebral abscess (1), leukemic meningitis (1), peripheral neuropathies (5), and myopathies (2). Forty patients (35%) had minor complications, including headache (16) and tremor(31). Major neurologic complications occurred after engraftment in most patients. Metabolic encephalopathy correlated with graft-versus-host disease(GVHD) (p < 0.03). Seven percent of patients had generalized seizures that occurred without signs of structural cerebral lesions. Probability of survival at day 90 was lower in patients with than in those without major central nervous system complications (63% versus 87.5%, p < 0.01).
Conclusions: Neurologic complications are frequent during the first 3 months following BMT and affect patient survival. Drug neurotoxicity and acute GVHD are the main factors influencing their occurrence.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Gorin NC, Gale RP, Armitage JO, Advisory Committee of the International Autologous Bone Marrow Transplant Registry (ABMTR). Autologous bone marrow transplants: different indications in Europe and in North America. Lancet 1989;2:317-318.
2.
Patchell RA. Neurological complications of organ transplantation. Ann Neurol 1994;36:688-703.
3.
Wiznitzer M, Packer RJ, August CS, Burkey ED. Neurological complications of bone marrow transplantation in childhood. Ann Neurol 1984;16:569-576.
4.
Snider S, Bashir R, Bierman P. Neurologic complications after high-dose chemotherapy and autologous bone marrow transplantation for Hodgkin's disease. Neurology 1994;44:681-684.
5.
Graus F, Saiz A, Sierra J, et al. Neurologic complications of autologous and allogeneic bone marrow transplantation in patients with leukemia: a comparative study. Neurology 1996;46:1004-1009.
6.
Gallardo D, Ferrà C, Berlanga JJ, et al. Neurologic complications after allogeneic bone marrow transplantation. Bone Marrow Transplant 1996;18:1135-1139.
7.
Patchell RA, White III CL, Clark AW, Beschorner WE, Santos GW. Neurologic complications of bone marrow transplantation. Neurology 1985;35:300-306.
8.
Mohrmann RL, Mah V, Vinters HV. Neuropathologic findings after bone marrow transplantation: an autopsy study. Hum Pathol 1990;21:630-639.
9.
Marcus RE, Goldman JM. Convulsions due to high-dose busulfan. Lancet 1984;2:1463-1464.
10.
Ghany AM, Tutschka PJ, McGhee RB, et al. Cyclosporine-associated seizures in bone marrow transplant recipients given busulfan and cyclophosphamide preparative therapy. Transplantation 1991;52:310-315.
11.
Sureda A, Perez de Oteyza J, Garcia-Larana J, Odriozola J. High dose busulfan and seizures. Ann Intern Med 1989;111:543-544.
12.
Thompson CB, June CH, Sullivan KM, Thomas ED. Association between cyclosporine neurotoxicity and hypomagnesemia. Lancet 1984;2:1116-1120.
13.
Reece DE, Frei-Lahr DA, Shepherd JD, et al. Neurologic complications in allogeneic bone marrow transplant patients receiving cyclosporine. Bone Marrow Transplant 1991;8:393-401.
14.
Johnson NT, Crawford SW, Sargure M. Acute acquired demyelinating polyneuropathy with respiratory failure following high-dose systemic cytosine arabinoside and marrow transplantation. Bone Marrow Transplant 1987;2:203-207.
15.
Greenspan A, Deeg HJ, Cottler-Fox M, Sirdofski M, Spitzer TR, Kattah J. Incapacitating peripheral neuropathy as a manifestation of chronic graft-versus-host disease. Bone Marrow Transplant 1990;5:349-352.
16.
Openshaw H, Hinton DR, Slatkin NE, Bierman PJ, Hoffman FM, Snyder DS. Exacerbation of inflammatory demyelinating polyneuropathy after bone marrow transplantation. Bone Marrow Transplant 1991;7:411-414.
17.
Eliashiv S, Brenner T, Abramsky O, et al. Acute inflammatory demyelinating polyneuropathy following bone marrow transplantation. Bone Marrow Transplant 1991;8:315-317.
18.
Amato AA, Barohn RJ, Sahenk Z, Tutschka PJ, Mendell JR. Polyneuropathy complicating bone marrow and solid organ transplantation. Neurology 1993;43:1513-1518.
19.
Papa G, Arcese W, Bianchi A, et al. Cyclosporine-associated bilateral deltoid paralysis after allogeneic bone marrow transplantation for chronic myelogenous leukemia. Haematologica 1985;70:273-274.
20.
Blin O, Desnelle C, Pellissier JF, et al. Neuropathie perpherique et ciclosporine A. A propos de deux cas. Therapie 1993;44:55-57.
21.
Anderson BA, Young V, Kean WF, et al. Polymyositis in chronic graft-versus-host disease. Arch Neurol 1982;39:188-190.
22.
Reyes MG, Noronha P, Thomas WJ, Heredia R. Myositis of chronic graft-versus-host disease. Neurology 1983;33:1222-1224.
23.
Urbano-Marquez A, Estruch R, Grau JM, et al. Inflammatory myopathy associated with chronic graft-versus-host disease. Neurology 1986;36:1091-1093.
24.
Pier N, Dubowitz V. Chronic graft-versus-host disease presenting with polymyositis. Br Med J (Clin Res) 1983;286:2024.
25.
Kimura J. Electrodiagnosis in diseases of nerve and muscle: principles and practice. Philadelphia: F.A. Davis, 1992.
26.
Elfenbein GJ, Saral R. Infectious disease during immune recovery after bone marrow transplantation. In: Infection and the compromised host. Baltimore: Williams and Wilkins, 1981:157-196.
27.
Meyers JD, Atkinson K. Infection in bone marrow transplantation. Clin Haematol 1983;12:791-811.
28.
Boston Collaborative Drug Surveillance Program. Acute adverse reactions to prednisone in relation to dosage. Clin Pharmacol Ther 1972;13:694-698.
29.
Kahan BD, Flechner SM, Lorber MI, et al. Complication of cyclosporine-prednisone immunosuppression in 402 renal allograft recipients exclusively followed at a single center from one to five years. Transplantation 1987;43:197-204.
30.
Walker RW, Brochstein JA. Neurologic complications of immunosuppressive agents. Neurol Clin 1988;6:261-278.
31.
Scherrer U, Vissing SF, Morgan BJ, et al. Cyclosporine-induced sympathetic activation and hypertension after heart transplantation. N Engl J Med 1990;323:693-699.
Information & Authors
Information
Published In
Copyright
© 1998.
Publication History
Published online: May 1, 1998
Published in print: May 1998
Authors
Metrics & Citations
Metrics
Citations
Download Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.
Cited By
- Epilepsy after acute central nervous system complications of pediatric hematopoietic cell transplantation: A retrospective, multicenter study, Seizure: European Journal of Epilepsy, 121, (85-90), (2024).https://doi.org/10.1016/j.seizure.2024.08.001
- Central nervous system complications after allogeneic hematopoietic stem cell transplantation: focusing on viral encephalitis and leukoencephalopathy同種造血幹細胞移植後の脳・神経合併症―ウイルス性脳炎と白質脳症を中心として―, Japanese Journal of Transplantation and Cellular Therapy, 12, 1, (35-42), (2023).https://doi.org/10.7889/tct-22-019
- Neurologic Considerations in Critically Ill Hematopoietic Stem Cell Transplantation Patients, Pulmonary and Critical Care Considerations of Hematopoietic Stem Cell Transplantation, (373-391), (2023).https://doi.org/10.1007/978-3-031-28797-8_29
- Toward a Better Understanding of the Atypical Features of Chronic Graft-Versus-Host Disease: A Report from the 2020 National Institutes of Health Consensus Project Task Force, Transplantation and Cellular Therapy, 28, 8, (426-445), (2022).https://doi.org/10.1016/j.jtct.2022.05.038
- Frequency and Risk Factors of Cyclosporine-Induced Neurotoxicity in Allogeneic Stem Cell Transplant Recipients, Cureus, (2021).https://doi.org/10.7759/cureus.19824
- Risk Factors for Seizures after Hematopoietic Stem Cell Transplantation in Pediatric Hemato-Oncologic Patients: A Single Tertiary Center Study in the Republic of Korea, Annals of Child Neurology, 29, 3, (115-123), (2021).https://doi.org/10.26815/acn.2021.00346
- Drug-Induced Seizures: Considerations for Underlying Molecular Mechanisms, International Journal of Toxicology, 40, 5, (403-412), (2021).https://doi.org/10.1177/10915818211040483
- Noninfectious neurologic complications of hematopoietic cell transplantation: A systematic review, Hematology/Oncology and Stem Cell Therapy, 14, 2, (87-94), (2021).https://doi.org/10.1016/j.hemonc.2020.05.006
- Mechanical Circulatory Support Prior to Heart Transplantation Predicts Early Post-Operative Stroke, The American Journal of the Medical Sciences, 362, 1, (34-38), (2021).https://doi.org/10.1016/j.amjms.2021.03.008
- Clinical risk factors and prognostic model for idiopathic inflammatory demyelinating diseases after haploidentical hematopoietic stem cell transplantation in patients with hematological malignancies, American Journal of Hematology, 96, 11, (1407-1419), (2021).https://doi.org/10.1002/ajh.26312
- See more
Loading...
View Options
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginPurchase Options
The neurology.org payment platform is currently offline. Our technical team is working as quickly as possible to restore service.
If you need immediate support or to place an order, please call or email customer service:
- 1-800-638-3030 for U.S. customers - 8:30 - 7 pm ET (M-F)
- 1-301-223-2300 for customers outside the U.S. - 8:30 - 7 pm ET (M-F)
- [email protected]
We appreciate your patience during this time and apologize for any inconvenience.