Severe neurologic complications after hematopoietic stem cell transplantation in children.
OBJECTIVE
To describe and evaluate the incidence and risk factors of severe neurologic events (SNE) in pediatric recipients of allogeneic or autologous hematopoietic stem cell transplantation (HSCT) for hematologic or nonhematologic diseases.


METHODS
Retrospective analysis of 272 consecutive children admitted to the G. Gaslini Children's Research Institute and given HSCT (70 from unrelated donors, 115 from related donors, and 87 autologous) between June 1985 and January 2001.


RESULTS
Thirty-seven children (13.6%) developed SNE after a median of 90 days (range, 5 days to 8.8 years) after HSCT. Cyclosporine A (CSA) neurotoxicity was the most frequent SNE (n = 21), followed by irradiation or chemotherapy injury (n = 7), CNS infections (n = 7), cerebrovascular events (n = 3), and immune-mediated etiology SNE (n = 2). Eleven patients (30%) died because of the neurologic complications. Type of HSCT, treatment with total body irradiation (TBI), acute graft-vs-host disease (GvHD), GvHD >grade 2, and treatment with CSA were associated with a significant increased risk of SNE.


CONCLUSIONS
Severe neurologic complications are frequent (14%) among children receiving HSCT, causing 8.5% of deaths after transplant. Transplant from allogeneic donor, especially if unrelated, the development of severe acute GvHD grade >2, and the use of TBI in the preparative regimen are the main risk factors for such complications.
Faraci
M
M
Department of Hematology/Oncology, Bone Marrow Transplant Unit, G. Gaslini Children's Research Institute, Genova, Italy. maurafaraci@ospedale-gaslini.ge.it
Lanino
E
E
Dini
G
G
Fondelli
M P
MP
Morreale
G
G
Dallorso
S
S
Manzitti
C
C
Calevo
M G
MG
Gaggero
R
R
Castagnola
E
E
Haupt
R
R
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects; D004569:Electroencephalography; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000401:mortality; D006402:Hematologic Diseases / Q000628:therapy; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008661:Metabolism, Inborn Errors / Q000628:therapy; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D009460:Neurologic Examination; D020258:Neurotoxicity Syndromes / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous / Q000009:adverse effects; D014916:Whole-Body Irradiation
D007166:Immunosuppressive Agents; D016572:Cyclosporine