Angiitis of the central nervous system after allogeneic bone marrow transplantation?

Background and Purpose-There is only limited information about late neurolo gical complications after bone marrow transplantation (BMT). The purpose of this study is to describe a cerebral angiitis-like syndrome after allogene ic BMT. Methods-Clinical and diagnostic findings of 5 BMT patients with chronic gra ft versus host disease and neuropathological data of 1 patient were reporte d. Results-In the described patients, focal neurological signs and neuropsycho logical abnormalities occurred years after BMT. MRI revealed periventricula r white matter lesions, lacunar or territorial infarctions, leukoencephalop athy, and hemorrhages. Angiitis of the central nervous system was confirmed in 1 patient at autopsy, and an angiitis-like syndrome was suspected in th e other patients because of the clinical course and response to treatment. Three patients received cyclophosphamide and steroids (2 improved, 1 died), 1 patient improved after steroids alone, and 1 patient without immunosuppr essive therapy deteriorated further. Conclusions-We propose that an angiitis-like syndrome of the central nervou s system can be a neurological manifestation of graft versus host disease, which should be considered a possible cause of cerebral ischemic episodes a nd pathological MRI scans in BMT patients with graft versus host disease.