Acute neurological complications after hematopoietic stem cell transplantation in children

Area of Science:

• Pediatric Hematology
• Neuroscience
• Transplantation Immunology

Background:

• Neurological complications (NC) are a concern for children undergoing hematopoietic stem cell transplantation (HSCT).
• While total body irradiation (TBI), busulfan, and cyclosporine A are known risk factors, others may contribute to NC.
• Identifying additional risk factors is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate pretransplantation parameters associated with the development of neurological complications (NC) in pediatric patients post-hematopoietic stem cell transplantation (HSCT).
• To identify novel risk factors beyond established ones for NC in this vulnerable population.

Main Methods:

• Retrospective review of medical records for 144 children (0-18 years) who underwent their first HSCT between 1995 and 2002.
• Analysis of pretransplantation parameters, including viral serologies and serum electrolyte levels.
• Correlation of these parameters with the incidence of NC within the first 3 months post-HSCT.

Main Results:

• Nineteen patients (13%) developed NC within 3 months post-HSCT.
• A higher number of positive herpes group viral serologies pre-HSCT was significantly associated with NC (p = 0.04).
• Cytomegalovirus (CMV)-positive recipients (p = 0.01) and electrolyte disturbances (sodium, potassium, calcium) also showed significant associations with NC.

Conclusions:

• Pretransplant herpes viral status and specific electrolyte imbalances are significant risk factors for neurological complications in children following HSCT.
• These findings highlight the importance of assessing viral serologies and electrolyte levels before transplantation to mitigate NC risk.
• Further research may explore targeted interventions based on these identified risk factors.