Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Post-Transplant Complications

Neuropathological findings after bone marrow transplantation: an autopsy study of 180 cases

Bone Marrow Transplantation volume 25, pages 301–307 (2000)Cite this article

Abstract

We prospectively evaluated the neuropathological complications of 180 patients who underwent autopsy studies following bone marrow transplantation (BMT) (177 allogeneic, three autologous). The most frequent underlying disorders included severe aplastic anemia (n = 55), chronic myelogenous leukemia (n = 53), acute myelogenous leukemia (n = 24) and Fanconi anemia (n = 16). There were 114 males and 66 females. Neuropathological findings were detected in 90.55% of the patients. The most frequent findings were subarachnoid hemorrhages (SAH) (n = 57), intraparenchymal hemorrhages (IHP) (n = 49), fungal infections (n = 16), Wernicke's encephalopathy (n = 10), microglial nodular encephalopathy (n = 10) and neurotoxoplasmosis (n = 8). In only 17 patients was the brain within normal limits. Survival time after BMT averaged 5.4 months and the majority of patients died in the first 3 months post BMT (n = 105). Central nervous system (CNS) pathology was the main cause of death in 17% of the patients (n = 31), with a predominance of IHP in this particular group. Furthermore, the survival time of these patients who died of CNS causes (96.3 days) was almost half of the survival time of those who died of extra-cerebral causes (177.8 days) (P = 0.0162). IHP (70.96 vs27.22%) (P < 0.001), fungal infections (25.8 vs 8.88%) (P < 0.001) and toxoplasmosis (9.67 vs 4.44%) (P < 0.001) were significantly more frequent in the group of patients who died due to CNS causes than in the control group. The findings of this work provide a possible guide to the possible causes of neurological syndromes following BMT. Bone Marrow Transplantation (2000) 25, 301–307.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

References

  1. Armitage JO . Bone marrow transplantation New Engl J Med 1994 330: 827–838

    Article  CAS  Google Scholar 

  2. Wiznitzer M, Packer RJ, August CS, Burkey ED . Neurological complications of bone marrow transplantation in children Ann Neurol 1984 16: 569–576

    Article  CAS  Google Scholar 

  3. Patchell RA, White CL III, Clark AW et al. Neurologic complications of bone marrow transplantation Neurology 1985 35: 300–306

    Article  CAS  Google Scholar 

  4. 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

    Article  CAS  Google Scholar 

  5. Mohrmann RL, Mah V, Vinters HV . Neuropathological findings after bone marrow transplantation: an autopsy study Hum Pathol 1990 21: 630–639

    Article  CAS  Google Scholar 

  6. Colvin RB, Bhan AK, McCluskey RT . Diagnostic Immunopathology, 2nd edn Raven Press: New York 1995

    Google Scholar 

  7. Bleggi-Torres LF, Medeiros BC, Werner B et al . Unusual presentation of cerebral toxoplasmosis after BMT Bone Marrow Transplant (accepted for publication)

  8. Graeber MB, Bise K, Mehraein P . CR3/43, a marker to human activated microglia: application to diagnostic neuropathology Neuropathol Appl Neurobiol 1994 20: 406–408

    Article  CAS  Google Scholar 

  9. Sullivan KM, Storb R, Shulman HM et al . Immediate and delayed neurotoxicity after mechlorethamine preparation for bone marrow transplantation Ann Intern Med 1982 97: 182–189

    Article  CAS  Google Scholar 

  10. Zimmer WE, Hourihane JM, Wang HZ, Schriber JR . The effect of human leukocyte antigen disparity on cyclosporine neurotoxicity after allogeneic bone marrow transplantation Am J Neuroradiol 1998 19: 601–610

    CAS  PubMed  Google Scholar 

  11. Antonini G, Ceschin V, Morino S et al. Early neurologic complications following allogeneic bone marrow transplant for leukemia: a prospective study Neurology 1998 50: 1441–1445

    Article  CAS  Google Scholar 

  12. Mehta J, Powles R, Singhal S et al. Early identification of patients at risk of death due to infections, haemorrhage, or graft failure after allogeneic bone marrow transplantation on the basis of leukocyte counts Bone Marrow Transplant 1997 19: 349–355

    Article  CAS  Google Scholar 

  13. Openshaw H, Slatjin NE . Neurological complications of bone marrow transplantation. In: Forman SJ, Blume KG, Thomas ED (eds) Bone Marrow Transplantation Blackwell Scientific Pub: Boston 1994 482–496

    Google Scholar 

  14. Zanis Neto J, Ribeiro RC, Medeiros CR et al. Bone marrow transplantation for patients with Fanconi anemia: a study of 24 cases from a single institution Bone Marrow Transplant 1995 15: 293–298

    CAS  PubMed  Google Scholar 

  15. Bombi JA, CArdesa A, Llebaria C et al. Main autopsy findings in bone marrow transplant patients Arch Pathol Lab Med 1987 111: 125–129

    CAS  PubMed  Google Scholar 

  16. Bleggi-Torres LF, Medeiros BC, Neto JZ et al. Disseminated fusarium sp infection affecting the brain of a child after bone marrow transplantation Bone Marrow Transplant 1996 18: 1013–1015

    CAS  PubMed  Google Scholar 

  17. Proctor SJ, Jackson GH . Intra-cerebral aspergillosis following allogeneic marrow transplantation responding to treatment with non-liposomal amphotericin B and rifampicin Br J Haematol 1997 98: 1048–1053

    Article  Google Scholar 

  18. Bleggi-Torres LF, Medeiros BC, Ogasawara VSA et al. Iatrogenic Wernicke's encephalopathy in allogenic bone marrow transplantation: a study of eight cases Bone Marrow Transplant 1997 20: 391–395

    Article  CAS  Google Scholar 

  19. Harper C . The incidence of Wernicke's encephalopathy in Australia – a neuropathological study of 131 cases J Neurol Neurosurg Psychiatry 1983 49: 341–345

    Article  Google Scholar 

  20. Peixoto MAL, Santos EC, Pittella JEH . Coma and death in unrecognized Wernicke's encephalopathy Arq Neuropsiquiat 1992 50: 329–333

    Article  Google Scholar 

  21. Zhang SX, Weilersbacher GS, Henderson SW et al. Excitotoxic cytopathology, progression and reversibility of thiamine deficiency-induced diencephalic lesions J Neuropathol Exp Neurol 1995 54: 255–267

    Article  CAS  Google Scholar 

  22. Budka H . Neuropathology of human immunodeficiency virus infection Brain Pathol 1991 1: 163–175

    Article  CAS  Google Scholar 

  23. Lantos PL, McLaughlin JE, Scholtz CL et al. Neuropathology of the brain in HIV infection Lancet 1989 11: 309–311

    Article  Google Scholar 

  24. Lassman H, Schmied M, Vass K et al. Bone marrow derived elements and resident microglia in brain inflammation Glia 1993 7: 19–24

    Article  Google Scholar 

Download references

Acknowledgements

We are indebted to Miss Heliz Regina Neves and Marco Bittencourt, MD for data analysis help.

Author information

Authors and Affiliations

  1. Department of Medical Pathology, Hospital de Clínicas, UFPR, Curitiba, Brazil

    LF Bleggi-Torres, BC de Medeiros, B Werner & G Loddo

  2. Bone Marrow Transplantation Unit, Hospital de Clínicas, UFPR, Curitiba, Brazil

    JZanis Neto, R Pasquini & CR de Medeiros

Authors
  1. LF Bleggi-Torres
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. BC de Medeiros
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B Werner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. JZanis Neto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G Loddo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R Pasquini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. CR de Medeiros
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bleggi-Torres, L., de Medeiros, B., Werner, B. et al. Neuropathological findings after bone marrow transplantation: an autopsy study of 180 cases. Bone Marrow Transplant 25, 301–307 (2000). https://doi.org/10.1038/sj.bmt.1702140

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1702140

Keywords

  • central nervous system
  • bone marrow transplantation
  • cerebrovascular disorders
  • infections

This article is cited by

Search

Advanced search

Quick links