Neuropathological findings after bone marrow transplantation: an autopsy study of 180 cases

We prospectively evaluated the neuropathological complications of 180 patie nts who underwent autopsy studies following bone marrow transplantation (BM T) (177 allogeneic, three autologous). The most frequent underlying disorde rs included severe aplastic anemia (n = 55), chronic myelogenous leukemia ( n = 53), acute myelogenous leukemia (n = 24) and Fanconi anemia (n = 16), T here were 114 males and 66 females. Neuropathological findings were detecte d in 90.55% of the patients. The most frequent findings were subarachnoid h emorrhages (SAH) (n = 57), intraparenchymal hemorrhages (IHP) (n = 49), fun gal infections (n = 16), Wernicke's encephalopathy (n = 10), microglial nod ular encephalopathy (n = 10) and neurotoxoplasmosis (n = 8), In only 17 pat ients was the brain within normal limits. Survival time after BMT averaged 5.4 months and the majority of patients died in the first 3 months post BMT (n = 105), Central nervous system (CNS) pathology was the main cause of de ath in 17% of the patients (n = 31), with a predominance of IHP in this par ticular group. Furthermore, the survival time of these patients who died of CNS causes (96.3 days) was almost half of the survival time of those who d ied of extra-cerebral causes (177.8 days) (P = 0.0162), IHP (70.96 vs 27.22 %) (P < 0.001), fungal infections (25.8 vs 8.88%) (P < 0.001) and toxoplasm osis (9.67 vs 4.44%) (P < 0.001) were significantly more frequent in the gr oup of patients who died due to CNS causes than in the control group. The f indings of this work provide a possible guide to the possible causes of neu rological syndromes following BMT.