NEUROLOGIC COMPLICATIONS AFTER ALLOGENEIC MARROW TRANSPLANTATION FOR SICKLE-CELL-ANEMIA

Seven of 21 patients with sickle cell anemia developed neurologic comp lications 5 to 243 days (median, 33 days) after allogeneic marrow tran splantation. Among these 7 patients, indications for transplantation i ncluded either a past history of stroke (4 patients) or recurrent seve re vaso-occlusive events (3 patients). All received marrow from an HLA -identical sibling after preparation with busulfan and cyclophosphamid e, and in 4 patients with antithymocyte globulin. Five of 6 patients d eveloping seizures received anticonvulsant and supportive treatment wi th resolution of neurologic abnormalities. Three patients experienced intracranial bleeding, which was fatal in two. Of the 14 patients free of neurologic complications, 4 patients had experienced stroke before transplantation. However, among all patients with prior stroke, the i ncidence of intracranial hemorrhage was 38% (3/8), whereas none of the 13 patients without prior stroke developed posttransplant intracrania l bleeding (P = .026). We conclude that patients with sickle cell anem ia are at increased risk for neurologic complications after marrow abl ative therapy and that patients with prior stroke are at increased ris k for intracranial hemorrhage. Transplantation of patients before the onset of overt stroke may reduce this risk. (C) 1995 by The American S ociety of Hematology.