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Neurological complications in adult allogeneic hematopoietic stem cell transplant patients: Incidence, characteristics and long-term follow-up in a multicenter series

Bone Marrow Transplantation volume 57, pages 1133–1141 (2022)Cite this article

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Abstract

Neurological complications (NCs) represent a diagnostic and clinical challenge in allogeneic hematopoietic stem cell transplant (alloHSCT) patients. We retrospectively analyzed NC incidence, etiology, timing, characteristics, outcome, and long-term effects in 2384 adult patients transplanted in seven Italian institutions between January 2007 and December 2019. Ninety-three (3.9%) patients were affected by 96 NCs that were infectious (29.2%), immune/inflammatory (26%), drug-related (12.5%), cerebrovascular (5.2%), metabolic (3.1%), related to central nervous system disease relapse (11.5%) and malignancy (3.1%), or undefined (9.4%). Six patients (6.4%) had neurological manifestations of chronic graft-versus-host disease (GVHD). NCs occurred on average at day +128 (from −5 to +4063). Early (< day +120) and late NCs had similar frequencies (46.9% vs 53.1%, p = 0.39). Thirty-one patients (33.3%) were affected by acute or chronic GVHD at the NC onset. With a median follow-up of 25.4 (0.4–163) months, the overall mortality due to NCs was 22.6%. The median time between NC onset and death was 36 (1–269) days. Infectious NCs were the main cause (61.9%) of NC-related mortality. A persistent neurological impairment occurred in 20.4% patients, 57.9% of whom being affected by immune/inflammatory NCs. This study highlights the rare, yet severe impact of alloHSCT-associated NCs on patient survival and long-term functional ability.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank all medical, nursing and health-care professionals as well as the administrative staff involved in the care of the patients of the seven bone marrow units participating in this study. Most thanks to the patients and their families who allowed their data to be analyzed and reported. This study did not receive funding or sponsorship.

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Authors and Affiliations

  1. Department of Medicine, Hematology and Bone Marrow Transplant Unit, Verona University, Verona, Italy

    Michele Wieczorek, Angelo Andreini, Beatrice De Marco, Mauro Krampera, Fabio Benedetti & Cristina Tecchio

  2. Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, Verona University, Verona, Italy

    Sara Mariotto, Sergio Ferrari & Diana Polo

  3. Hematology and Bone Marrow Transplant Unit, Ospedale Regionale San Maurizio, Bolzano, Italy

    Federico Mosna

  4. Hematology and Bone Marrow Transplant Unit, Ospedale Papa XXIII, Bergamo, Italy

    Maria Caterina Micò & Anna Grassi

  5. Cell Therapy and Hematology, Ospedale San Bortolo, Vicenza, Italy

    Carlo Borghero

  6. Division of Hematology and Stem Cell Transplant, ASUFC, University Hospital of Udine, Udine, Italy

    Maria Vittoria Dubbini & Anna Candoni

  7. Department of Clinical and Experimental Sciences, Unit of Blood Disease and Stem Cell Transplantation, Brescia University, Brescia, Italy

    Michele Malagola

  8. Hematology and Bone Marrow Transplant Unit, Ospedale dell’Angelo, Venezia, Italy

    Cristina Skert

  9. Department of Diagnostics and Public Health, Epidemiology and Medical Statistics Unit, Verona University, Verona, Italy

    Ahmad Tfaily

  10. Department of Neurosciences, Neurology Unit, Ospedale San Bortolo, Vicenza, Italy

    Federica Ranzato

  11. Department of Clinical and Experimental Sciences, Neurology Unit, Brescia University, Brescia, Italy

    Irene Volonghi

  12. Neurology Unit, Ospedale dell’Angelo, Venezia, Italy

    Rocco Quatrale

Authors
  1. Michele Wieczorek
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Contributions

MW performed the research and wrote the paper, SM and SF analyzed the data, FM, MCM, CB, MVD, MM, CS, BDM, AA, DP, MK, AG, AC, FR, IV, RQ and BF provided the data and revised the paper, AT performed the statistical analyses, CT designed the study, analyzed the data, and wrote the paper.

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Correspondence to Cristina Tecchio.

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Wieczorek, M., Mariotto, S., Ferrari, S. et al. Neurological complications in adult allogeneic hematopoietic stem cell transplant patients: Incidence, characteristics and long-term follow-up in a multicenter series. Bone Marrow Transplant 57, 1133–1141 (2022). https://doi.org/10.1038/s41409-022-01690-x

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