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Post-Transplant Complications

Encephalopathy in pediatric patients after allogeneic hematopoietic stem cell transplantation is associated with a poor prognosis

Bone Marrow Transplantation volume 33, pages 1151–1157 (2004)Cite this article

Summary:

Encephalopathy is a poorly characterized complication of hematopoietic stem cell transplantation (HSCT). No comprehensive report of encephalopathy exists for children, and the literature contains only a few for adults. We analyzed a large cohort of 405 pediatric patients who underwent allogeneic HSCT during a 10-year period and identified 26 patients (6.4%) who experienced encephalopathy. Identifiable causes of encephalopathy included infection (n=5), single or multiorgan failure (n=4), medication-related complications (n=3), nonconvulsive seizures (n=4), acute disseminated encephalomyelitis (n=2), thrombotic thrombocytopenic purpura (n=2), and stroke (n=1). We were unable to identify the etiology of encephalopathy in five (19%) patients. The prognosis for pediatric patients with encephalopathy was poor: only four (15%) experienced complete neurologic recovery, and 10 (38%) patients experienced partial recovery with residual neurologic deficits. Nine (35%) patients with complete or partial recovery survive long term. A total of 17 patients died; one died of progressive encephalopathy, and 16 died of either relapse of primary disease or toxicity. MRI, CSF analysis including molecular testing for infectious pathogens, and brain biopsy were helpful in obtaining a diagnosis in most of our patients. However, a standardized approach to accurate and timely diagnosis and treatment is needed to improve outcome in these patients.

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Acknowledgements

This work was supported in part by Cancer Center Support (CORE) Grant P30 CA 21765 from the National Cancer Institute and by the American Lebanese Syrian Associated Charities (ALSAC). We express our appreciation to the nurses, nurse practitioners, and physician assistants involved in the care of these patients and to the Department of Scientific Editing for review of this manuscript.

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Authors and Affiliations

  1. Division of Stem Cell Transplantation, Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN, USA

    P Woodard, H McDaniel, G Hale, E Benaim, K Kasow, W Leung, E Horwitz, U Yusuf, J M Cunningham & R Handgretinger

  2. Department of Radiological Sciences, St Jude Children's Research Hospital, Memphis, TN, USA

    K Helton, R B Khan & S Thompson

  3. Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA

    D K Srivastava & X Tong

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  1. P Woodard
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  2. K Helton
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  6. G Hale
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  14. J M Cunningham
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Correspondence to P Woodard.

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Woodard, P., Helton, K., McDaniel, H. et al. Encephalopathy in pediatric patients after allogeneic hematopoietic stem cell transplantation is associated with a poor prognosis. Bone Marrow Transplant 33, 1151–1157 (2004). https://doi.org/10.1038/sj.bmt.1704480

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  • DOI: https://doi.org/10.1038/sj.bmt.1704480

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