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Published on: May 26, 2021
Life-threatening neurological complications after bone marrow transplantation in children
D Uckan1, M Cetin, I Yigitkanli
1Department of Pediatrics, Units of Bone Marrow Transplantation and Hematology, Hacettepe University Faculty of Medicine, Children's Hospital, Yenisehir, Ankara 06100, Turkey. duckan@hacettepe.edu.tr
Insights
Neurological complications after bone marrow transplantation (BMT) are serious, affecting nearly 10% of pediatric patients. Risk factors include underlying disease, mismatched donors, and graft-versus-host disease, impacting survival.
Area of Science:
- Pediatric Hematology
- Neuroscience
- Transplantation Immunology
Background:
- Neurological complications are a significant concern in bone marrow transplant (BMT) recipients, contributing to morbidity and mortality.
- These complications can arise from various factors including toxicity, infections, and graft-versus-host disease (GvHD).
Purpose of the Study:
- To identify the incidence and types of life-threatening neurological complications in pediatric BMT recipients.
- To determine the risk factors associated with the development of severe neurological complications post-BMT.
Main Methods:
- Retrospective analysis of 113 pediatric patients undergoing BMT.
- Detailed review of neurological events, diagnoses, and transplant characteristics.
- Exclusion of minor neurological symptoms like reversible seizures.
Main Results:
- Life-threatening neurological complications occurred in 9.7% of pediatric BMT recipients.
- Common causes included Cyclosporine A toxicity (6 cases), intracranial hemorrhage (3 cases), and sustained hypertension (3 cases).
- Risk factors identified were advanced stage acute myeloblastic leukemia (AML), mismatched transplantation, older age, and >grade II GvHD.
Conclusions:
- Severe neurological complications represent a critical challenge in pediatric BMT.
- Identifying and mitigating risk factors such as advanced AML, mismatched transplants, and GvHD is crucial for improving outcomes.
Abstract:
Neurological complications may occur in BMT recipients (11-59%), frequently contributing to morbidity or mortality. They are the main causes of death in 10-15%. Life-threatening neurological complications were seen in 11 out of 113 (9.7%) children who underwent BMT from HLA-matched family (n=7) or mismatched donors (n=4) at our institution. Diagnoses of patients with neurological complications were acute myeloblastic leukemia (AML) (five), thalassemia major (two), Fanconi anemia (two), Omenn syndrome (one) and leukodystrophy (one), and the neurological events were seen between days +13 and +85 after transplantation. Minor symptoms including reversible, nonrepetitive seizures were excluded. Cyclosporine A toxicity was diagnosed in six children. The rest of the complications were brain abscess/meningoencephalitis (two), severe hypomagnesemia (one), busulfan toxicity (one), sustained hypertension (three), and intracranial hemorrhage (three). Six patients with neurological complications suffered from >grade II graft-versus-host disease (GvHD), and all were high risk for transplant-related complications. In this study, risk status of the underlying disease, mismatched transplantation, a diagnosis of AML (advanced stage), older age and >grade II GvHD were important adverse factors for the development of severe life-threatening neurological complications.
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