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The aim of this study was to assess neurological,neuropsychological and neuroradiological findings in long term survivors of allogeneic bone marrow transplantation(BMT)who were recruited from a hematological outpatient clinic.In addition,risk factors for the development of late neurological complications were identified.In contrast to previous studies on autopsied patients,our study design provoked a bias away from increased neurological sequelae because patients with early complications after BMT were excluded.Fifty-nine allogeneic patients and 7 autologous BMT patients underwent clinical examination,short neuropsychological testing and cranial magnetic resonance imaging(MRI)26 months after BMT.The pathological results of the neurological examination(abnormal 64%)and the MRI examination(white matter lesions,54%;atrophy,11%)were associated with the occurrence of chronic graft-versus-host disease(GvHD)evolving from acute GvHD with corticosteroid therapy and with cyclosporine medication. Neuropsychological impairment(cognitive deficits,37%)was associated with long term cyclosporine medication and age.No influence of pre-BMT disease, BMT donor status or the conditioning regimen was found.These results suggest that the frequent neurological abnormalities in long term survivors of allogeneic BMT are associated with chronic GvHD and with resulting immunosuppression as major risk factors. |
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