Central nervous system disorders after hematopoietic stem cell transplantation: a prospective study of the Infectious Diseases Working Party of EBMT: Journal of Neurology

M. Schmidt-Hieber, D. Engelhard, A. Ullmann, P. Ljungman, J. Maertens, R. Martino, M. Rovira, P.J. Shaw, C. Robin, M. Faraci, J. Byrne, K. Schäfer-Eckart, H. Einsele, E. Faber, L. Rigacci, R. Saccardi, A. Balaguer-Rosello, C. Isaksson, M. Christopeit, G. TridelloJ. Wang, N. Knelange, M. Mikulska, S. Cesaro, J. Styczynski

Research output: Contribution to journalArticlepeer-review

Abstract

We performed a prospective study to evaluate the types and characteristics of central nervous system (CNS) disorders in patients after hematopoietic stem cell transplantation. The study included 163 episodes of CNS disorders of which 58 (36%) were infections. Proven or probable infections were documented in 34 patients and included fungi (n = 10, 29%), viruses (n = 12, 35%), Toxoplasma spp. (n = 9, 27%) and bacteria (n = 3, 9%). Non-infectious neurological disorders (n = 105, 64%) frequently encompassed metabolic/drug-induced abnormalities (n = 28, 27%) or cerebral vascular events (n = 22, 21%). Median onset times were later for infectious (day + 101) vs non-infectious neurological disorders (day + 50, p = 0.009). An unremarkable cranial CT scan was found in 33% of infection episodes. Absence of cerebrospinal fluid pleocytosis despite a normal or increased peripheral blood white blood cell count occurred in 26% of infections. Day-30 mortality rates were significantly higher for fungal (87%) vs non-fungal infections (40%, p < 0.001). Significantly higher mortality rates were also documented for cerebral vascular events than for other non-infectious disorders (86% vs 34%, p < 0.001). Our prospective study shows that diagnostic findings in CNS infections might differ between hematopoietic stem cell transplant recipients and immunocompetent hosts. Special awareness and timely initiation of adequate diagnostics are crucial to improve the prognosis of these patients. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
Original languageEnglish
Pages (from-to)430-439
Number of pages10
JournalJ. Neurol.
Volume267
Issue number2
DOIs
Publication statusPublished - 2020

Keywords

  • cyclosporine
  • steroid
  • thymocyte antibody
  • acute graft versus host disease
  • acute leukemia
  • Adenoviridae
  • adolescent
  • adult
  • aged
  • allogeneic hematopoietic stem cell transplantation
  • Article
  • Aspergillus
  • autologous hematopoietic stem cell transplantation
  • bacterial infection
  • brain ventriculitis
  • central nervous system aspergillosis
  • central nervous system disease
  • central nervous system infection
  • cerebral toxoplasmosis
  • cerebrovascular disease
  • child
  • chronic graft versus host disease
  • chronic lymphatic leukemia
  • drug induced disease
  • electroencephalography
  • Enterovirus
  • Epstein Barr virus
  • female
  • Filobasidiella
  • Glasgow coma scale
  • hematopoietic stem cell transplantation
  • Herpes simplex virus
  • human
  • Human herpesvirus 6
  • immunosuppressive treatment
  • JC virus
  • leukocyte count
  • major clinical study
  • male
  • metabolic encephalopathy
  • mortality rate
  • multiple myeloma
  • mycosis
  • myelodysplastic syndrome
  • myeloproliferative neoplasm
  • neuroimaging
  • neurologic disease
  • outcome assessment
  • pleocytosis
  • priority journal
  • prognosis
  • prospective study
  • retrospective study
  • Toxoplasma
  • treatment outcome
  • Varicella zoster virus
  • virus infection
  • whole body radiation
  • adverse event
  • infant
  • middle aged
  • preschool child
  • young adult
  • Adolescent
  • Adult
  • Aged
  • Central Nervous System Infections
  • Cerebrovascular Disorders
  • Child
  • Child, Preschool
  • Female
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Prospective Studies
  • Young Adult

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