Neurological Complications Following Allogeneic Haematopoietic Stem Cell Transplantation

Allogeneic hematopoietic stem-cell transplantation (Allo-SCT) has become the standard of care for a number of malignant and non-malignant disorders. Neurological complications associated with these procedures remain frequent. These complications result from a variety of causes. Known risk factors include the underlying disorder, therapies used for immunosuppression, especially the use of cyclosporine A or FK506, and toxicities from radiation or chemotherapy, but other risk factors might also be of importance. We retrospectively analyzed neurological complications of 152 patients (range 10–49 years old) who underwent Allo-SCT in our transplantation center between August 2005 and July 2008. In all, there were 95 (62.5%) cases of unrelated donor transplantation, 54 (35.5%) cases of sibling donor transplantation, and 3 (2.0%) cases of haploidentical transplantation. Post-SCT neurological complications were seen in 16(10.5%) patients. They were seen in 4 cases after related donor SCT and in 12 cases after unrelated donor SCT. Neurological symptoms occurred between day −4 day and +512 day after transplantation. The complications included 4 cases with relapsed leukemia of central nervous system (2 in ALL, 1 in CML, 1 in AML), 3 cases with encephalorrhagia, 3 cases with epilepsy, 2 cases with demyelinating disease, 2 cases with encephalitis, 1 cases with multiple myositis,1 cases with peripheral neuritis. Seven cases died of neurological complication, including 4 with relapsed leukemia of central nervous system and 3 with encephalorrhagia. Other patients were cured. High dose gamma globulin conbined with Methylprednisolone were used in demyelinating disease. Antiepileptic agents were used in epilepsy. Cyanocobalamin was used in peripheral neuritis. In conclusion, neurological complications commonly occurred in Allo-SCT, and encephalorrhagia might be the main indication that needs intensive care. Moreover, central nervous system leukemia and demyelinating disease, multiple myositis should have clinical interests.