Central nervous system dysfunction as the first manifestation of multiple organ dysfunction syndrome in stem cell transplant patients

Development of CNS dysfunction in the setting of hematopoietic stem cell tr ansplant (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 d ysfunction syndrome (MODS) after HSCT, Twenty-one of 186 patients undergoin g 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 wit h 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 wi thout progression to second organ dysfunction, and 90% of these patients su rvived to day 100, Fifty-two percent of patients with CNS dysfunction progr essed 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 progr essed to second organ dysfunction and those who did not were not different in terms of type of HSCT (allogeneic vs autologous), stem cell source (bloo d vs bane marrow), age, diagnosis or preparative regimen. Development of CN S dysfunction in the setting of HSCT, as with other organ dysfunctions (suc h as hepatic veno-occlusive disease), probably represents an early manifest ation of a systemic disorder predisposing for MODS, increasing the risk of transplant-related mortality. Early systemic therapies directed at modulati ng this systemic disorder are probably indicated.