title: Encephalopathy in pediatric patients after allogeneic hematopoietic stem cell transplantation is associated with a poor prognosis.
abstract: Encephalopathy is a poorly characterized complication of hematopoietic stem cell transplantation (HSCT). No comprehensive report of encephalopathy exists for children, and the literature contains only a few for adults. We analyzed a large cohort of 405 pediatric patients who underwent allogeneic HSCT during a 10-year period and identified 26 patients (6.4%) who experienced encephalopathy. Identifiable causes of encephalopathy included infection (n=5), single or multiorgan failure (n=4), medication-related complications (n=3), nonconvulsive seizures (n=4), acute disseminated encephalomyelitis (n=2), thrombotic thrombocytopenic purpura (n=2), and stroke (n=1). We were unable to identify the etiology of encephalopathy in five (19%) patients. The prognosis for pediatric patients with encephalopathy was poor: only four (15%) experienced complete neurologic recovery, and 10 (38%) patients experienced partial recovery with residual neurologic deficits. Nine (35%) patients with complete or partial recovery survive long term. A total of 17 patients died; one died of progressive encephalopathy, and 16 died of either relapse of primary disease or toxicity. MRI, CSF analysis including molecular testing for infectious pathogens, and brain biopsy were helpful in obtaining a diagnosis in most of our patients. However, a standardized approach to accurate and timely diagnosis and treatment is needed to improve outcome in these patients.
authors.affiliation: Division of Stem Cell Transplantation, Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. Paul.Woodard@stjude.org
authors.forename: P
authors.initials: P
authors.lastname: Woodard
authors.forename: K
authors.initials: K
authors.lastname: Helton
authors.forename: H
authors.initials: H
authors.lastname: McDaniel
authors.forename: R B
authors.initials: RB
authors.lastname: Khan
authors.forename: S
authors.initials: S
authors.lastname: Thompson
authors.forename: G
authors.initials: G
authors.lastname: Hale
authors.forename: E
authors.initials: E
authors.lastname: Benaim
authors.forename: K
authors.initials: K
authors.lastname: Kasow
authors.forename: W
authors.initials: W
authors.lastname: Leung
authors.forename: E
authors.initials: E
authors.lastname: Horwitz
authors.forename: D K
authors.initials: DK
authors.lastname: Srivastava
authors.forename: X
authors.initials: X
authors.lastname: Tong
authors.forename: U
authors.initials: U
authors.lastname: Yusuf
authors.forename: J M
authors.initials: JM
authors.lastname: Cunningham
authors.forename: R
authors.initials: R
authors.lastname: Handgretinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001927:Brain Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006402:Hematologic Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous