Hideki Arioka

Neurological complications after stem cell transplantation in childhood

We analyzed the incidence of neurological complications in 77 patients receiving stem cell transplantation (SCT), and 12 patients (15.8%) had the following symptoms: convulsions, intracranial hemorrhage, and leukoencephalopathy. Although statistically not significant, neurological complications were seen more frequently in patients after allogeneic transplantation, and in those with acute graft-versus-host disease (GVHD) exceeding grade II. The most significant risk factor for neurological complications was identified as unrelated donor allogenic transplantation (P = 0.016). Complications were categorized into three groups, based on time of onset and symptoms: (1) convulsions during the conditioning period, (2) intracranial hemorrhage during the period of granulocyte recovery, and (3) leukoencephalopathy at around 2 months after SCT. We propose awareness of the risks of neurological complications in each period after SCT so that immediate and effective treatment of patients can be instigated.

Electroencephalogram abnormality and high-dose busulfan in conditioning regimens for stem cell transplantation

High-dose busulfan (BU) is widely used in combined chemotherapy before allogeneic or autologous bone marrow transplantation. Convulsions are reported as a side-effect of high-dose BU. We recorded electroencephalograms (EEGs) before and on the third day of BU administration in 22 patients. Abnormal EEGs were observed on the third day in 13 cases (59%). These patients were older (P < 0.05) and had had larger doses of bu (P < 0.025) than the nine patients with normal eegs. convulsions occurred in two of the 22 patients, one of whom was receiving prophylaxis with phenytoin. gamma aminobutyric acid (gaba), a natural mediator of defense against epileptic activity, concentrations in cerebrospinal fluid measured before and after administration of bu showed no definite changes.

Prolonged Bone Marrow Failure With Monosomy 7 After Engraftment Failure Following Bone Marrow Transplantation

A patient with acute myelogenous leukemia developed prolonged bone marrow failure along with the monosomy 7 chromosome abnormality.The patient had undergone bone marrow transplantation with CD34+ selection following induction failure. However, she then suffered engraftment failure and long-term pancytopenia. Her white blood cell count gradually increased with supportive therapy including granulocyte colony-stimulating factor (G-CSF), and chromosomal analysis of bone marrow cells revealed an abnormal karyotype.Thirty months after the bone marrow transplantation we observed monosomy 7 together with the existing chromosomal abnormality in the patient’s bone marrow cells. It has been reported that some patients with idiopathic and posthepatitis aplastic anemia develop clonal disorders such as myelodysplastic syndrome/acute myelogenous leukemia with monosomy 7. The findings in our case suggest that the appearance of monosomy 7 in patients with aplastic anemia may be caused by prolonged low-level hematopoiesis, with or without G-CSF stimulation.

Painless and Safe Subcutaneous Catheter for Injection of Various Cytokines in Patients with Hematological Disorders

Various cytokines have been used to treat patients with hematological disorders, eg, recombinant granulocyte colony-stimulating factor (G-CSF),1 recombinant granulocyte-macrophage colony-stimulating factor (GM-CSF),2 and erythropoietin (EPO) are given to patients with aplastic anemia (AA). G-CSF and GM-CSF are also used to treat neutropenia in patients with leukemia, lymphoma, and other solid tumors who receive such treatment as intensive chemotherapy.3 Interferon (IFN)-gamma is used to treat patients with chronic granulomatous disease (CGD).4 Generally these cytokines are administered either intravenously or subcutaneously. However, it is difficult to continue intravenous injection for long periods, especially in children. One of the major problems associated with the subcutaneous route is pain. Recently, teflon catheters have been used for daily painless injections of insulin by subcutaneous inplantation into the abdominal wall of diabetic patients.5