Abstract
Development of CNS dysfunction in the setting of hematopoietic stem cell transplant (HSCT) has been previously shown to predict for subsequent second organ dysfunction and death. In this paper, we describe the characteristics of this isolated CNS dysfunction, and its relationship to multiple organ dysfunction syndrome (MODS) after HSCT. Twenty-one of 186 patients undergoing HSCT developed CNS dysfunction as their first organ dysfunction a mean of 22.8 ± 0.9 days after the start of the preparative regimen. Compared with 137 patients who developed no organ dysfunction, patients presenting with CNS dysfunction were more likely to have undergone allogeneic HSCT (P = 0.001) and to have received a total body irradiation-based regimen (P = 0.001), and were less likely to have been transplanted for lymphoma (P = 0.008). Patients who developed CNS dysfunction were more likely to die than those with no organ dysfunction (P < 0.001). of the 21 patients who developed cns dysfunction, 48% resolved their dysfunction by a mean of 4.6 days later without progression to second organ dysfunction, and 90% of these patients survived to day 100. fifty-two percent of patients with cns dysfunction progressed to second organ dysfunction (pulmonary or hepatic) a mean of 5.5 days later, and only 36% survived to day 100 (P = 0.02). The patients who progressed to second organ dysfunction and those who did not were not different in terms of type of HSCT (allogeneic vs autologous), stem cell source (blood vs bone marrow), age, diagnosis or preparative regimen. Development of CNS dysfunction in the setting of HSCT, as with other organ dysfunctions (such as hepatic veno-occlusive disease), probably represents an early manifestation of a systemic disorder predisposing for MODS, increasing the risk of transplant-related mortality. Early systemic therapies directed at modulating this systemic disorder are probably indicated. Bone Marrow Transplantation (2000) 25, 79–83.
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References
Knaus WA, Draper EA, Wagner DP, Zimmerman JE . Prognosis in acute organ-system failure Ann Surg 1985 202: 685–693
Faist FN, Baue AE, Dittmer H, Heberer G . Multiple organ failure in polytrauma patients J Trauma 1983 9: 775–787
Goris RJ, te Boekhorst TP, Nuytinck JK, Gimbrere JS . Multiple-organ failure Arch Surg 1985 20: 1109–1115
McDonald GB, Hinds MS, Fisher LD et al. Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients Ann Int Med 1993 118: 255–267
Haire WD, Ruby EI, Gordon BG et al. Multiple organ dysfunction syndrome in bone marrow transplantation J Am Med Assoc 1995 274: 1289–1295
Folstein MF, Folstein SE, McHugh PR . ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician J Psychiatr Res 1975 12: 189–198
McDonald GB, Sharma P, Matthews DE et al. Veno-occlusive disease of the liver after bone marrow transplantation. Diagnosis, incidence and predisposing factors Hepatology 1984 4: 116–122
Jones RJ, Lee KS, Beschorner WE et al. Venocclusive disease of the liver following bone marrow transplantation Transpl 1987 44: 778–783
Wiznitzer M, Packer RJ, August CS, Burkey ED . Neurologic complications of bone marrow transplantation in childhood Ann Neurol 1984 16: 569–576
Patchell RA, White CL, Clark AW et al. Neurologic complications of bone marrow transplantation Neurol 1985 35: 300–306
Graus F, Saiz A, Sierra J et al. Neurologic complications of autologous and allogeneic bone marrow transplantation in patients with leukemia: a comparative study Neurol 1996 46: 1004–1009
Antonini G, Ceschin V, Morino S et al. Early neurologic complications following allogeneic bone marrow transplant for leukemia: a prospective study Neurol 1998 50: 1441–1445
Snider S, Bashir R, Bierman P . Neurologic complications after high-dose chemotherapy and autologous bone marrow transplantation for Hodgkin's disease Neurol 1994 44: 681–684
Furlong TG, Gallucci BB . Patterns of occurrence and clinical presentation of neurological complications in bone marrow transplant patients Cancer Res 1994 17: 27–36
Anthony RC, LeResche L, Niaz U et al. Limits of the ‘Mini-Mental State’ as a screening test for dementia and delirium among hospital patients Psychol Med 1982 12: 397–408
Faioni EM, Krachmalnicoff A, Bearman SI et al. Naturally occurring anticoagulants and bone marrow transplantation: plasma protein C predicts the development of venocclusive disease of the liver Blood 1993 81: 3458–3462
Gordon BG, Tarantolo SR, Ruby EI et al. Increased platelet transfusion requirement is associated with multiple organ dysfunctions in patients undergoing hematopoietic stem cell transplantation Bone Marrow Transplant 1998 22: 999–1003
Rio B, Andreu G, Nicod A et al. Thrombocytopenia in veno-occlusive disease after bone marrow transplantation or chemotherapy Blood 1986 67: 1773–1776
Bone RC . Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome Ann Int Med 1996 125: 680–687
Haire WD . The multiple organ dysfunction syndrome in cancer patients undergoing hematopoietic stem cell transplantation Semin Thromb Hemost 1999 25: 223–237
Haire WD, Stephens LC, Ruby EI . Systemic inflammatory response syndrome (SIRS), sepsis and organ dysfunction in bone marrow transplantation (BMT) Blood 1996 88: (Suppl. 1) 255b (3748)
Dickniete G, Paques EP . Reduction of mortality with antithrombin III in septicemic rats: a study of Klebsiella pneumoniae induced sepsis Thromb Haemost 1993 69: 98–102
Phillips TF, Staricco A, Assarian GS et al. Antithrombin administration protects from experimental DIC Blood 1983 62: (Suppl. 1) 308a
Haire WD, Stephens LC, Ruby EI . Antithrombin III (AT3) treatment of organ dysfunction during bone marrow transplantation (BMT): results of a pilot study Blood 1996 88: (Suppl. 1) 458a
Morris J, Harris RE, Hashmi R et al. Antithrombin-III for the treatment of chemotherapy-induced organ dysfunction following bone marrow transplantation Bone Marrow Transplant 1997 20: 871–878
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Gordon, B., Lyden, E., Lynch, J. et al. Central nervous system dysfunction as the first manifestation of multiple organ dysfunction syndrome in stem cell transplant patients. Bone Marrow Transplant 25, 79–83 (2000). https://doi.org/10.1038/sj.bmt.1702082
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DOI: https://doi.org/10.1038/sj.bmt.1702082
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