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Pediatric Transplants

Diagnostic and therapeutic implications of neurological complications following paediatric haematopoietic stem cell transplantation

Abstract

Neurological complications are a relevant cause of morbidity and mortality after haematopoietic stem cell transplantation (SCT). We retrospectively analysed neurological complications of 165 paediatric patients who underwent SCT between 1996 and 2003. In all, 111 (67%) transplantations were allogeneic and 54 (33%) transplantations were autologous. Post-SCT neurological complications were seen in 24% of patients. They were seen in six children after autologous SCT and in 11 and 23 cases after allogeneic-related and -unrelated SCT. Neurological symptoms occurred between day +22 and +912 after transplantation and were classified into two groups. The first group (n=21) offered non-repetitive symptoms lasting less than 24 h without any cerebral imaging and cerebrospinal fluid(CSF) abnormalities. The second group (n=19) was characterized by progressive neurological symptoms, pathological MRI findings and/or abnormal results in CSF. Those with a progressive clinical course resulted from infections (n=10), drug toxicity (n=5), cerebrovascular events (n=2) and the central nervous system (CNS) relapse of the underlying disease (n=2). In particular, cerebral aspergillosis and toxoplasmosis after allogeneic unrelated SCT are a major challenge and are associated with a high mortality. In conclusion, our data suggest that patients presenting with progressive neurological symptoms after SCT require prompt diagnostic procedures and initiation in antimicrobial therapy in case of any findings suggestive of CNS infection.

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Acknowledgements

We thank Mrs M Schmitz for her excellent assistance in data collection and evaluation. We also thank the nursing team of the BMT unit for excellent patient care. The early recognition and adequate treatment of threatening situations would not have been possible without their knowledge and experience.

In particular, we acknowledge the ‘Elterninitiative Kinderkrebsklinik eV, Düsseldorf’ for their commitment to the long-standing and continuous support of the stem cell transplantation programme and the oncology staff.

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Correspondence to H-J Laws.

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Weber, C., Schaper, J., Tibussek, D. et al. Diagnostic and therapeutic implications of neurological complications following paediatric haematopoietic stem cell transplantation. Bone Marrow Transplant 41, 253–259 (2008). https://doi.org/10.1038/sj.bmt.1705905

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  • DOI: https://doi.org/10.1038/sj.bmt.1705905

Keywords

  • neurological complications
  • children
  • SCT
  • CNS

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