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J Neurol. 2019 Oct 29. doi: 10.1007/s00415-019-09578-5. [Epub ahead of print]

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

Author information

1
Clinic for Hematology and Oncology, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Germany. m.schmidt_hieber@ctk.de.
2
Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
3
Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.
4
Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
5
Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.
6
Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
7
Department of Hematology, Institute of Hematology and Oncology, IDIBAPS, Hospital Clinic, University of Barcelona, Josep Carreras Leukemia Research Institute, Barcelona, Spain.
8
The Children's Hospital at Westmead, Sydney, Australia.
9
Assistance Publique-Hopitaux de Paris, Henri Mondor University Hospital, Hematology Department and UPEC, Créteil France Hôspital Henri Mondor, Créteil, France.
10
Hematopoietic Stem Cell Unit Transplantation, IRCCS Instituto G. Gaslini, Genova, Italy.
11
Nottingham University Hospital, Nottingham, UK.
12
Clinic for Hematology and Oncology, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg, Germany.
13
Department of Hemato-Oncology, Faculty Hospital Olomouc, Faculty of Medicine and Dentistry Palacky University, Olomouc, Czech Republic.
14
Ospedale S. Camillo, Rome, Italy.
15
Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
16
Hospital Universitari I Politècnic La Fe, Valencia, Spain.
17
Umea University Hospital, Umeå, Sweden.
18
Department of Stem Cell Transplantation, University Medical Center Eppendorf, Hamburg, Germany.
19
Pediatric Hematology Oncology, Mother and Child Hospital, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
20
EBMT Data Office, Leiden, The Netherlands.
21
Division of Infectious Diseases, University of Genova, DISSAL, Genoa, Italy.
22
IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
23
Department of Pediatric Hematology and Oncology, Collegium Medicum UMK, Bydgoszcz, Poland.

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.

PMID:
31664549
DOI:
10.1007/s00415-019-09578-5

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