Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Jan;68(1):36–40. doi: 10.1136/jnnp.68.1.36

Increased incidence of neurological complications in patients receiving an allogenic bone marrow transplantation from alternative donors

C de Brabander 1, J Cornelissen 1, P Smitt 1, C Vecht 1, M J van den Bent 1
PMCID: PMC1760639  PMID: 10601399

Abstract

OBJECTIVE—To compare the frequency and type of neurological complications after bone marrow transplantation (BMT) with an HLA identical unrelated donor or a mismatched related donor (alternative donors) to the neurological complications after matched sibling BMT for standard and high risk leukaemia or myelodysplastic syndromes.
METHODS—Retrospective analysis of consecutively treated patients with (a) BMT from alternative donors (n=39), (b) treated with matched sibling BMT for standard risk leukaemia, myelodysplastic syndromes, or aplastic anaemia (n=53), and (c) treated with matched sibling BMT for high risk leukaemia, myelodysplastic syndromes, or aplastic anaemia (n=49).
RESULTS—A total of 72 neurological complications were found. Most of these occurred within the first 6 months after transplant. Thirty six patients developed a severe neurological complication: 17Alternative donor patients (44%) by contrast with six standard risk patients (11%) and 13 high risk patients (27%; p<0.005). The most frequent complication was a metabolic encephalopathy occurring in 18% of patients. Most of the encephalopathies were caused by either the transplant procedure, cyclosporin, systemic infections, microangiopathic thrombopathy, or by complications induced by graft versus host disease. Infections of the CNS developed in 9% of patients, cerebrovascular lesions in 3%.
CONCLUSIONS—Severe neurological complications are more frequent after BMT from alternative donors. This is mainly due to increased treatment related morbidity and to more profound immunosuppression after BMT from alternative donors.



Full Text

The Full Text of this article is available as a PDF (78.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Antonini G., Ceschin V., Morino S., Fiorelli M., Gragnani F., Mengarelli A., Iori A. P., Arcese W. Early neurologic complications following allogeneic bone marrow transplant for leukemia: a prospective study. Neurology. 1998 May;50(5):1441–1445. doi: 10.1212/wnl.50.5.1441. [DOI] [PubMed] [Google Scholar]
  2. Bird G. L., Meadows J., Goka J., Polson R., Williams R. Cyclosporin-associated akinetic mutism and extrapyramidal syndrome after liver transplantation. J Neurol Neurosurg Psychiatry. 1990 Dec;53(12):1068–1071. doi: 10.1136/jnnp.53.12.1068. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dellemijn P. L., Brandenburg A., Niesters H. G., van den Bent M. J., Rothbarth P. H., Vlasveld L. T. Successful treatment with ganciclovir of presumed Epstein-Barr meningo-encephalitis following bone marrow transplant. Bone Marrow Transplant. 1995 Aug;16(2):311–312. [PubMed] [Google Scholar]
  4. Derouin F., Devergie A., Auber P., Gluckman E., Beauvais B., Garin Y. J., Lariviere M. Toxoplasmosis in bone marrow-transplant recipients: report of seven cases and review. Clin Infect Dis. 1992 Aug;15(2):267–270. doi: 10.1093/clinids/15.2.267. [DOI] [PubMed] [Google Scholar]
  5. Erer B., Polchi P., Lucarelli G., Angelucci E., Baronciani D., Galimberti M., Giardini C., Gaziev D., Maiello A. CsA-associated neurotoxicity and ineffective prophylaxis with clonazepam in patients transplanted for thalassemia major: analysis of risk factors. Bone Marrow Transplant. 1996 Jul;18(1):157–162. [PubMed] [Google Scholar]
  6. Gharpure V. S., Hutchinson R. M., Durrant S. T. Migraine after bone-marrow transplantation. Lancet. 1990 Jan 6;335(8680):57–57. doi: 10.1016/0140-6736(90)90191-7. [DOI] [PubMed] [Google Scholar]
  7. Goulden N. J., Cornish J. M., Potter M. N., Pamphilon D. H., Steward C. G., Oakhill A. Bone marrow transplantation from volunteer unrelated donors. Cancer Treat Rev. 1995 Jul;21(4):325–353. doi: 10.1016/0305-7372(95)90036-5. [DOI] [PubMed] [Google Scholar]
  8. Graus F., Saiz A., Sierra J., Arbaiza D., Rovira M., Carreras E., Tolosa E., Rozman C. Neurologic complications of autologous and allogeneic bone marrow transplantation in patients with leukemia: a comparative study. Neurology. 1996 Apr;46(4):1004–1009. doi: 10.1212/wnl.46.4.1004. [DOI] [PubMed] [Google Scholar]
  9. Hinchey J., Chaves C., Appignani B., Breen J., Pao L., Wang A., Pessin M. S., Lamy C., Mas J. L., Caplan L. R. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996 Feb 22;334(8):494–500. doi: 10.1056/NEJM199602223340803. [DOI] [PubMed] [Google Scholar]
  10. Jerman M. R., Fick R. B., Jr Nonbacterial thrombotic endocarditis associated with bone marrow transplantation. Chest. 1986 Dec;90(6):919–922. doi: 10.1378/chest.90.6.919. [DOI] [PubMed] [Google Scholar]
  11. Kalhs P., Brugger S., Schwarzinger I., Greinix H. T., Keil F., Kyrle P. A., Knöbl P., Schneider B., Höcker P., Linkesch W. Microangiopathy following allogeneic marrow transplantation. Association with cyclosporine and methylprednisolone for graft-versus-host disease prophylaxis. Transplantation. 1995 Nov 15;60(9):949–957. [PubMed] [Google Scholar]
  12. Kernan N. A., Bartsch G., Ash R. C., Beatty P. G., Champlin R., Filipovich A., Gajewski J., Hansen J. A., Henslee-Downey J., McCullough J. Analysis of 462 transplantations from unrelated donors facilitated by the National Marrow Donor Program. N Engl J Med. 1993 Mar 4;328(9):593–602. doi: 10.1056/NEJM199303043280901. [DOI] [PubMed] [Google Scholar]
  13. Marks D. I., Cullis J. O., Ward K. N., Lacey S., Syzdlo R., Hughes T. P., Schwarer A. P., Lutz E., Barrett A. J., Hows J. M. Allogeneic bone marrow transplantation for chronic myeloid leukemia using sibling and volunteer unrelated donors. A comparison of complications in the first 2 years. Ann Intern Med. 1993 Aug 1;119(3):207–214. doi: 10.7326/0003-4819-119-3-199308010-00005. [DOI] [PubMed] [Google Scholar]
  14. Mohrmann R. L., Mah V., Vinters H. V. Neuropathologic findings after bone marrow transplantation: an autopsy study. Hum Pathol. 1990 Jun;21(6):630–639. doi: 10.1016/s0046-8177(96)90010-6. [DOI] [PubMed] [Google Scholar]
  15. Murakami S., Mizobuchi M., Nakashiro Y., Doi T., Hato N., Yanagihara N. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med. 1996 Jan 1;124(1 Pt 1):27–30. doi: 10.7326/0003-4819-124-1_part_1-199601010-00005. [DOI] [PubMed] [Google Scholar]
  16. Ochs L., Shu X. O., Miller J., Enright H., Wagner J., Filipovich A., Miller W., Weisdorf D. Late infections after allogeneic bone marrow transplantations: comparison of incidence in related and unrelated donor transplant recipients. Blood. 1995 Nov 15;86(10):3979–3986. [PubMed] [Google Scholar]
  17. Patchell R. A., White C. L., 3rd, Clark A. W., Beschorner W. E., Santos G. W. Neurologic complications of bone marrow transplantation. Neurology. 1985 Mar;35(3):300–306. doi: 10.1212/wnl.35.3.300. [DOI] [PubMed] [Google Scholar]
  18. Petersdorf E. W., Longton G. M., Anasetti C., Martin P. J., Mickelson E. M., Smith A. G., Hansen J. A. The significance of HLA-DRB1 matching on clinical outcome after HLA-A, B, DR identical unrelated donor marrow transplantation. Blood. 1995 Aug 15;86(4):1606–1613. [PubMed] [Google Scholar]
  19. Pomeranz S., Naparstek E., Ashkenazi E., Nagler A., Lossos A., Slavin S., Or R. Intracranial haematomas following bone marrow transplantation. J Neurol. 1994 Feb;241(4):252–256. doi: 10.1007/BF00863777. [DOI] [PubMed] [Google Scholar]
  20. Reece D. E., Frei-Lahr D. A., Shepherd J. D., Dorovini-Zis K., Gascoyne R. D., Graeb D. A., Spinelli J. J., Barnett M. J., Klingemann H. G., Herzig G. P. Neurologic complications in allogeneic bone marrow transplant patients receiving cyclosporin. Bone Marrow Transplant. 1991 Nov;8(5):393–401. [PubMed] [Google Scholar]
  21. Rubin A. M., Kang H. Cerebral blindness and encephalopathy with cyclosporin A toxicity. Neurology. 1987 Jun;37(6):1072–1076. doi: 10.1212/wnl.37.6.1072. [DOI] [PubMed] [Google Scholar]
  22. Salloum E., Khan K. K., Cooper D. L. Chlorambucil-induced seizures. Cancer. 1997 Mar 1;79(5):1009–1013. doi: 10.1002/(sici)1097-0142(19970301)79:5<1009::aid-cncr18>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  23. Snider S., Bashir R., Bierman P. Neurologic complications after high-dose chemotherapy and autologous bone marrow transplantation for Hodgkin's disease. Neurology. 1994 Apr;44(4):681–684. doi: 10.1212/wnl.44.4.681. [DOI] [PubMed] [Google Scholar]
  24. Steiger M. J., Farrah T., Rolles K., Harvey P., Burroughs A. K. Cyclosporin associated headache. J Neurol Neurosurg Psychiatry. 1994 Oct;57(10):1258–1259. doi: 10.1136/jnnp.57.10.1258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Thompson C. B., June C. H., Sullivan K. M., Thomas E. D. Association between cyclosporin neurotoxicity and hypomagnesaemia. Lancet. 1984 Nov 17;2(8412):1116–1120. doi: 10.1016/s0140-6736(84)91556-3. [DOI] [PubMed] [Google Scholar]
  26. Wiznitzer M., Packer R. J., August C. S., Burkey E. D. Neurological complications of bone marrow transplantation in childhood. Ann Neurol. 1984 Nov;16(5):569–576. doi: 10.1002/ana.410160507. [DOI] [PubMed] [Google Scholar]
  27. de Groen P. C., Aksamit A. J., Rakela J., Forbes G. S., Krom R. A. Central nervous system toxicity after liver transplantation. The role of cyclosporine and cholesterol. N Engl J Med. 1987 Oct 1;317(14):861–866. doi: 10.1056/NEJM198710013171404. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES