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Neurological complications of bone marrow transplantation in childhood
Insights
Bone marrow transplantation often leads to neurological issues in children. Central nervous system and peripheral nervous system dysfunctions are common, impacting long-term survivors.
Area of Science:
- Pediatric Hematology/Oncology
- Neuroscience
- Transplantation Medicine
Background:
- Bone marrow transplantation (BMT) is a critical treatment for pediatric cancers, aplastic anemia, and metabolic disorders.
- BMT protocols utilize immunosuppressive and cytotoxic agents, which carry inherent risks of neurotoxicity.
- Neurological complications following BMT in pediatric populations are a significant concern.
Purpose of the Study:
- To investigate the incidence and types of neurological abnormalities in pediatric patients undergoing BMT.
- To identify risk factors and specific neurological sequelae associated with BMT in children.
- To compare neurological complication rates in BMT patients versus non-BMT patients with similar conditions.
Main Methods:
- Retrospective analysis of 57 pediatric patients (median age 11 years) who underwent BMT.
- Clinical assessment for central nervous system (CNS) and peripheral nervous system (PNS) dysfunction.
- Review of postmortem examinations for CNS abnormalities.
- Comparison of neurological complication rates with historical controls.
Main Results:
- 59% of patients developed neurological abnormalities.
- Central nervous system (CNS) dysfunction occurred in 46% of patients, including infections, cerebrovascular accidents, CNS leukemia, and metabolic encephalopathy.
- Neuropsychological dysfunction was noted in 4 of 5 long-term survivors; 74% of postmortem exams revealed CNS abnormalities.
- Peripheral nervous system (PNS) dysfunction was observed in 24% of patients.
- CNS dysfunction and specific complications like cerebrovascular accidents and infections were more frequent in BMT patients, particularly those with lymphoreticular malignancies.
Conclusions:
- Pediatric patients undergoing BMT are at high risk for significant neurological and neuropsychological sequelae.
- The preparative regimens and prior treatments contribute to these neurological complications.
- Early identification and management of neurological complications are crucial for improving outcomes in pediatric BMT survivors.
Abstract:
Bone marrow transplantation, used in the treatment of cancer, aplastic anemia, and metabolic diseases, involves the use of potentially neurotoxic agents to suppress immunity and eradicate malignancy. Fifty-seven patients with a median age of 11 years (age range, 6 months to 24 years) underwent bone marrow transplantation at the Children's Hospital of Philadelphia. Fifty-nine percent developed neurological abnormalities. Twenty-six patients (46%) had central nervous system (CNS) dysfunction, including infection (8), cerebrovascular accident (5), CNS leukemia (7), metabolic encephalopathy (5), and paraparesis with CNS toxoplasmosis (1). Neuropsychological dysfunction was present in 4 of 5 long-term survivors who were tested. Fourteen of 19 patients (74%) on whom postmortem examination was performed were found to have CNS abnormalities, including cerebral atrophy (10), focal cerebral injury (6), leukemia (5), and infection (3). Fourteen patients (24%) had peripheral nervous system dysfunction. CNS dysfunction was more common in patients with lymphoreticular malignancies. Cerebrovascular accidents (in patients with lymphoreticular malignancies) and infections (in our general population and in patients with lymphoreticular malignancies) occurred more often in our patients than in patients with similar illnesses who did not undergo bone marrow transplantation. The combination of prior treatment and preparative therapy for bone marrow transplantation predisposes patients to neurological and neuropsychological sequelae.