Neurologic Complications After Bone Marrow ... - Blood Journal

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Neurologic Complications After Bone Marrow Transplantation for Sickle Cell Anemia. To the Editor: Since 1988, 12 SCA patients received transplants for severeĀ ...
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Neurologic Complications After BoneMarrow Transplantation for Sickle Cell Anemia To the Editor: Recently, Walters et a l l reported their experience on neurologic complications after allogeneic marrow transplantation for sickle cell anemia (SCA). Seven of the 21 reported patients developed neurologic complications: 5 of 6 patients with seizures recovered and 3 had intracranial bleeding (which was fatal in 2).

Since 1988, 12 SCA patients received transplants for severe clinical disease in our institution? Five of them have had a stroke before transplantation (Table 1). Three of them (60%) present seizures after transplantation, whereas among children with no previous neurologic event, seizures occurred only in 1 (14%). No intracranial hemorrhage occurred. With supportive care, 3 patients recovered and returned to their baseline situation (Table 2). One patient developed mild

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409 Table 1. Patient Characteristics

Patient No.

2

1 2

3 4

5 6

7 8 11

Age (yr)

Prior Stroke

No Normal exam withnohistoryofdysfunctionhormal cranial CT No Normal exam withnohistory of dysfunctionlnormal cranial CT NoNormal exam with no historyof dysfunction/normal cranial CT NoNormal exam withnohistoryofdysfunctionhormal cranial CT NoNormal exam withnohistory of dysfunctionlnormal cranial CT Yes History of recurrent hemiparesishormal cranial CT History of seizure and comalnormal cranial CT Normal No exam history with no of dysfunction/normal cranial CT NoNormal exam withnohistoryofdysfunctionlnormal cranial CT Yes History of episodes ofconfusionhultiple small subcortical infarctions on CT Yes History ofleft hemiparesishnultiple small subcortical infarctions; large rightfrontal and parietal cortical, subcortical and deep white matter infarction Yes History of central facial paralysis/multiple small subcortical infarctions, cortical infarction in the left frontal and temporoparietal areas

10 10 4 2 7 Yes 13 14

'h

9 10 11

6

12

8

Pretransplant Neurologic Status: Clinical/lmaging

6

Imaging: All CT or CT and MRI. Abbreviation: CT, computed tomography; MRI, magnetic resonance imaging.

Table 2. Neurologic Events After Transplantation Patient No.

130/80 1 Seizures 10

Event

Day Posttransplant

12 Seizures 160/100

38

Seizures

11

140/100

10

Seizures

12

140/80

81

BP (mm Hg)

19 127

HgB Ig/dL)

PLT (x109/~)

9 7.6

48 86

10.4 9.8

Neuroimaging Study

Normal cranial CT MRI: no change from baseline MRI: no change from baseline MRI: no change from baseline

Outcome

No sequella No sequella Return to baseline Development of mild spastic hemiparesis

Abbreviations: BP, blood pressure; HgB, hemoglobin; PLT, platelet.

spastic hemiparesis, without magnetic resonance imaging (MRI) changes in neuroimaging studies. Our single-center experience confirms the high frequency of neurologic complications after marrow transplantation for SCA, mainly in patients with previous stroke and/or pretransplant abnormal neuroimaging studies.

Alina Ferster Catherine Christophe Bernard Dan Christine Devalck Eric Sariban

Department of Hematology/Oncology H6pital Universitaire des Enfants Reine Fabiola Brussels, Belgium

REFERENCES 1 . Walters MC, Sullivan KM, Bernaudin F, Souillet G, Vannier JP, Johnson FL, Lenarsky C, Powars D, Bunin N, Ohene-Frempong K, Wall D, Michel G, Plouvier E, Bordigoni P, Lutz P, Sanders JE, Matthews DC, Patience M, Appelbaum FR, Storb R: Neurologic complications after allogenic marrow transplantation for Sickle Cell Anemia. Blood 85:879, 1995 2. Ferster A, Devalck C, Azzi N, Fondu P, Toppet M, Sariban E: Bone marrow transplantation for severe sickle cell anemia. Br J Haematol 820: 102, 1992