Intracranial hemorrhage following bone marrow transplantation: an autopsy study of 58 patients

• Published in: Bone marrow transplantation (Basingstoke) Vol. 29; no. 1; pp. 29 - 32
• Main Authors: BLEGGI-TORRES, L. F, WERNER, B, GASPARETTO, E. L, DE MEDEIROS, B. C, PASQUINI, R, DE MEDEIROS, C. R
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 2002
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Autopsy; Biological and medical sciences; Bone marrow; Bone Marrow Transplantation - adverse effects; Bone marrow, stem cells transplantation. Graft versus host reaction; Brazil - epidemiology; Case-Control Studies; Cause of Death; Chi-Square Distribution; Child; Child, Preschool; Female; Graft vs Host Disease; Hematologic Diseases - complications; Hematologic Diseases - mortality; Hematologic Diseases - therapy; Humans; Intracranial Hemorrhages - etiology; Intracranial Hemorrhages - mortality; Intracranial Hemorrhages - pathology; Male; Medical sciences; Middle Aged; Multivariate Analysis; Stem cell transplantation; Survival Rate; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Brazil; Human; Intracranial; Nervous system diseases; Stem cell; Hematopoietic cell; Homograft; Cardiovascular disease; Hemorrhage; Vascular disease; Autopsy; Bone marrow; Graft; Complication; Cerebrovascular disease
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1703315

Autopsy files of 180 patients were reviewed, who died after BMT between July 1987 and June 1998 and 58 (32.2%) cases, who had experienced intracranial hemorrhage (ICH) were selected. Age, sex, underlying disease, preparatory regimens, immunoprophylaxis, chronic and acute GVHD, survival of the patients and localization and size of hemorrhages were evaluated. There were 33 males and 25 females, with a mean age of 23.4 years. The main underlying disorders for which BMT was performed included SAA (n = 21), CML (n = 13) and AML (n = 10). Forty patients were found to have intraparenchymal hemorrhage, 35 had subarachnoid hemorrhage and eight patients had subdural hemorrhage. In 16 cases the CNS hemorrhage was so extensive that it was considered to be the main cause of death. There was no significant statistical difference concerning sex (P = 0.217), age (P = 0.296), underlying disease (P= 0.352), preparatory regimens (P = 0.07), immunoprophylaxis (P = 0.914), chronic and acute graft-versus-host disease (P = 0.107 and P = 0.631, respectively) and survival (P = 0.701) when comparing patients with or without ICH. However, the number of cases in which the CNS was defined as the main cause of death was higher among patients with ICH than in patients without ICH (n = 16 vs 15) (P = 0.011). We conclude that ICH is common and has a significant mortality rate following BMT.