title: Neurological complications of transplantation: part I: hematopoietic cell transplantation.
abstract: Hematopoietic cell transplantation (HCT) is the preferred treatment for an expanding range of neoplastic and nonmalignant conditions. Increasing numbers of solid organ transplantations (SOTs) add an additional population of immunosuppressed patients with multiple potential neurological problems. While the spectrum of neurological complications varies with conditioning procedure and hematopoietic cell or solid organ source, major neurological complications occur with all transplantation procedures. This 2 part review emphasizes a practical consultative approach to central and peripheral nervous system problems related to HCT or SOT with clinical and neuroimaging examples from the authors' institutional experience with the following conditions: the diversity of manifestations of common infections such as varicella zoster virus, Aspergillus, and progressive multifocal leukoencephalopathy (PML), drug therapy-related complications, stroke mechanisms, the spectrum of graft versus host disease (GVHD), and neurologically important syndromes of immune reconstitution inflammatory syndrome (IRIS), posterior reversible encephalopathy syndrome (PRES), and posttransplantation lymphoproliferative disorder (PTLD). These complications preferentially occur at specific intervals after HCT and SOT, and neurological consultants must recognize an extensive spectrum of syndromes in order to effect timely diagnosis and expedite appropriate treatment.
authors: Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Amy A
authors: AA
authors: Pruitt
authors: Francesc
authors: F
authors: Graus
authors: Myrna R
authors: MR
authors: Rosenfeld
keywords: Aspergillus; graft versus host disease; hematopoietic cell transplantation; immune reconstitution inflammatory syndrome; organ transplantation; posterior reversible encephalopathy syndrome; posttransplantation lymphoproliferative disorder; progressive multifocal leukoencephalopathy; varicella zoster virus
references: Bone Marrow Transplant. 2008 Feb;41(3):253-9
references: 17982498
references: J Clin Oncol. 2009 Aug 10;27(23):e46-7
references: 19451419
references: J Neurol Neurosurg Psychiatry. 2010 Mar;81(3):247-54
references: 19828476
references: Cleve Clin J Med. 2011 Nov;78 Suppl 2:S38-41
references: 22123934
references: AIDS. 1997 Jan;11(1):1-17
references: 9110070
references: Bone Marrow Transplant. 2007 Jan;39(2):101-7
references: 17143300
references: Transpl Infect Dis. 2007 Mar;9(1):3-10
references: 17313464
references: Biol Blood Marrow Transplant. 2007 Oct;13(10):1192-200
references: 17889356
references: Stroke. 1999 Aug;30(8):1651-6
references: 10436117
references: Clin Exp Dermatol. 2009 Mar;34(2):199-201
references: 18793307
references: Clin Infect Dis. 2005 Nov 1;41(9):1242-50
references: 16206097
references: Clin Infect Dis. 2007 Jun 15;44(12):e115-7
references: 17516390
references: Biol Blood Marrow Transplant. 2007 Nov;13(11):1369-79
references: 17950923
references: Pediatr Transplant. 2008 Dec;12(8):914-7
references: 18503483
references: Arch Neurol. 2005 Jun;62(6):873-82
references: 15956158
references: Curr Treat Options Neurol. 2008 May;10(3):178-85
references: 18579021
references: N Engl J Med. 2006 Apr 27;354(17):1813-26
references: 16641398
references: Neurology. 2009 Nov 3;73(18):1507-8
references: 19884579
references: Neurology. 2006 Dec 12;67(11):1990-7
references: 17159106
references: N Engl J Med. 2006 May 25;354(21):2235-49
references: 16723615
references: Bone Marrow Transplant. 1999 Feb;23(4):397-9
references: 10100585
references: J Pediatr Hematol Oncol. 2007 Jan;29(1):66-8
references: 17230071
references: Clin Neuropharmacol. 2009 Sep-Oct;32(5):293-4
references: 19820432
references: Blood. 2009 May 14;113(20):4834-40
references: 19264918
references: Lancet Neurol. 2009 Aug;8(8):731-40
references: 19608099
references: Drug Saf. 2008;31(11):989-96
references: 18840018
references: Br J Haematol. 2006 Jan;132(2):245-7
references: 16398660
references: J Clin Neurosci. 2009 Dec;16(12):1688-90
references: 19800799
references: AJNR Am J Neuroradiol. 2005 Mar;26(3):654-6
references: 15760882
references: J Oncol Pharm Pract. 2008 Sep;14(3):157-62
references: 18719071
references: Eur Radiol. 2003 Feb;13(2):377-88
references: 12599004
references: Bone Marrow Transplant. 2000 Feb;25(3):301-7
references: 10673702
references: Biol Blood Marrow Transplant. 2009 Oct;15(10):1143-238
references: 19747629
references: Clin Pharmacol Ther. 2007 Sep;82(3):325-9
references: 17637786
references: Hepatology. 2010 Apr;51(4):1450-60
references: 20373370
references: Semin Neurol. 2004 Dec;24(4):427-34
references: 15637654
references: Bone Marrow Transplant. 2007 Oct;40(8):709-19
references: 17603513
references: Intern Med. 2009;48(16):1453-6
references: 19687597
references: Semin Neurol. 2011 Apr;31(2):202-15
references: 21590625
references: AJR Am J Roentgenol. 2007 Oct;189(4):904-12
references: 17885064
references: Neurology. 2011 Feb 15;76(7):672-4
references: 21321342
references: Lancet Neurol. 2010 Apr;9(4):425-37
references: 20298966
references: AJNR Am J Neuroradiol. 2009 Aug;30(7):1371-9
references: 19386731
references: Bone Marrow Transplant. 2002 Jun;29(11):913-6
references: 12080357
references: Ann Hematol. 2003 Jan;82(1):37-40
references: 12574963
references: Cleve Clin J Med. 2007 Jul;74(7):489-94, 496, 498-9 passim
references: 17682626
references: Neurology. 2004 Dec 28;63(12):2423-5
references: 15623719
references: Bone Marrow Transplant. 2010 Mar;45(3):593-6
references: 19684631
references: Ophthalmology. 2009 Sep;116(9):1624-9
references: 19729097
references: Semin Oncol. 2006 Jun;33(3):352-61
references: 16769425
references: Bone Marrow Transplant. 2004 Jul;34(2):137-42
references: 15235576
references: Clin Infect Dis. 2009 Jan 15;48(2):e9-e15
references: 19072243
references: Bone Marrow Transplant. 1998 Nov;22(9):873-81
references: 9827815
references: Radiol Clin North Am. 2008 Mar;46(2):397-417, x
references: 18619387
references: Arq Neuropsiquiatr. 2008 Sep;66(3B):685-90
references: 18949262
references: Arch Neurol. 2008 Dec;65(12):1612-8
references: 19064748
references: Arch Neurol. 2010 Mar;67(3):298-304
references: 20212227
references: Bone Marrow Transplant. 2008 Jun;41 Suppl 2:S49-57
references: 18545245
references: Neurol Clin. 2003 Feb;21(1):319-52
references: 12690654
references: Neurology. 2010 Jul 6;75(1):89-91
references: 20603489
references: Lancet Oncol. 2009 Aug;10(8):816-24
references: 19647202
references: Bone Marrow Transplant. 2001 Jul;28(1):1-12
references: 11498738
references: Bone Marrow Transplant. 2005 Jun;35(11):1123-4
references: 15821770
references: Semin Neurol. 2009 Apr;29(2):136-53
references: 19370494
references: Neurology. 2003 Mar 11;60(5):842-8
references: 12629244
references: Int J Hematol. 2008 Sep;88(2):145-148
references: 18604650
references: Neurology. 2007 Aug 28;69(9):894-7
references: 17724292
references: Nat Clin Pract Neurol. 2009 Mar;5(3):163-9
references: 19262592
references: Antimicrob Agents Chemother. 2009 May;53(5):1840-9
references: 19258267
references: Br J Haematol. 2007 Aug;138(4):559-60
references: 17587337
references: Bone Marrow Transplant. 2005 Jan;35(1):71-6
references: 15531898
references: Br J Dermatol. 2006 Aug;155(2):344-9
references: 16882173
references: Neurology. 2007 Jul 10;69(2):156-65
references: 17620548
references: Neuropediatrics. 2008 Oct;39(5):249-51
references: 19294596
references: Clin Oncol (R Coll Radiol). 2007 Mar;19(2):108-14
references: 17355105
references: Seizure. 2011 Jan;20(1):93-5
references: 21115371
references: Br J Haematol. 2002 May;117(2):451-68
references: 11972533
references: Arch Neurol. 2003 Jan;60(1):107-12
references: 12533096
references: Br J Haematol. 2006 Jan;132(1):3-12
references: 16371014
references: Bone Marrow Transplant. 2007 Jul;40(2):183-4
references: 17502894
references: Wien Klin Wochenschr. 2005 Mar;117(5-6):229-33
references: 15875764
references: Int J Hematol. 2006 Oct;84(3):272-5
references: 17050204
references: Drugs. 2008;68(14):1941-62
references: 18778118
references: Neurology. 2007 Mar 13;68(11):859-61
references: 17353475
references: Arch Neurol. 2009 May;66(5):659-61
references: 19433668
references: Neurology. 2002 Dec 24;59(12):1994-7
references: 12499502
references: Eur J Radiol. 2007 Jun;62(3):454-9
references: 17218075
references: Am J Med. 2012 Jan;125(1 Suppl):S39-51
references: 22196208
references: Lancet. 2009 Sep 12;374(9693):912-20
references: 19729196
references: Clin Infect Dis. 2007 Mar 15;44(6):857-66
references: 17304461
references: Biol Blood Marrow Transplant. 2009 Jan;15(1):92-100
references: 19135947
references: Mayo Clin Proc. 2010 May;85(5):427-32
references: 20435835
references: Bone Marrow Transplant. 2007 Jan;39(1):49-52
references: 17099715
references: N Engl J Med. 2003 May 29;348(22):2196-203
references: 12773646
references: Neurology. 2000 Jun 13;54(11):2147-50
references: 10851379
references: N Engl J Med. 2008 Jun 12;358(24):2619-28
references: 18550878
references: Arch Neurol. 2006 Jul;63(7):940-2
references: 16682531
references: Bone Marrow Transplant. 2008 Mar;41(5):415-23
references: 18209726
references: N Engl J Med. 2011 Oct 13;365(15):1417-24
references: 21995389
references: Science. 2004 Nov 19;306(5700):1380-3
references: 15550673
references: Neurology. 2009 Apr 28;72(17):1458-64
references: 19129505
references: Haematologica. 2008 Mar;93(3):e36-7
references: 18310533
references: Brain. 2010 Oct;133(10):2852-65
references: 20846944
references: Biol Blood Marrow Transplant. 2009 Nov;15(11):1439-46
references: 19822304
references: Br J Ophthalmol. 2003 Jan;87(1):121-2
references: 12488279