Early central nervous system complications after reduced-intensity stem cell transplantation.
To investigate clinical characteristics of early central nervous system (CNS) complications after reduced-intensity stem cell transplantation (RIST), we reviewed the medical records of 232 patients who had undergone RIST for hematologic diseases at our institutions between September 1999 and June 2003. All patients had received purine analog-based preparative regimens. Stem cell sources comprised granulocyte colony-stimulating factor-mobilized blood from HLA-identical or 1 locus-mismatched related donors (n = 151), unrelated bone marrow (n = 44), or unrelated cord blood (n = 37). Graft-versus-host disease prophylaxis incorporated cyclosporine with or without methotrexate. Diagnosis of CNS complications was based on clinical, radiologic, and microbiological findings. CNS complications occurred in 18 patients (7.8%), with a median onset of 22 days, and were infectious (n = 1), metabolic (n = 15), or cerebrovascular (n = 2). Symptoms included seizures (n = 7), visual disturbance (n = 2), headache (n = 8), nausea (n = 8), vomiting (n = 6), impaired consciousness (n = 16), and hemiparesis (n = 3). Complications improved promptly in 10 patients, and 8 patients died without improvement within 30 days. Multivariate analysis with logistic regression identified umbilical cord blood transplantation as a significant risk factor for early CNS complications (odds ratio, 14.5; 95% confidence interval, 3.7-56.9; P <.0001). CNS complications are a significant problem after RIST, particularly with umbilical cord blood. Limbic encephalopathy is an unrecognized subtype of neurotoxicity after umbilical cord blood transplantation.
Hematopoietic Stem-Cell Transplantation Unit, the National Cancer Center Hospital, Tokyo, Japan.
Yukiko
Y
Kishi
Shigesaburo
S
Miyakoshi
Masahiro
M
Kami
Masayuki
M
Ikeda
Yuta
Y
Katayama
Naoko
N
Murashige
Eiji
E
Kusumi
Koichiro
K
Yuji
Kazuhiko
K
Kobayashi
Daisuke
D
Kato
Tamae
T
Hamaki
Tomoko
T
Matsumura
Sung-Won
SW
Kim
Shinichi
S
Morinaga
Shinichiro
S
Mori
Mineo
M
Kanemaru
Tatsuyuki
T
Hayashi
Yoichi
Y
Takaue
Shuichi
S
Taniguchi
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D001928:Brain Diseases, Metabolic / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000517:prevention & control; D006402:Hematologic Diseases / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D020363:Limbic Encephalitis / Q000150:complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D016572:Cyclosporine