03.15.21

Association of Graft-Versus-Host-Disease with Neurologic Complications- Clinical Paradigm and Future Directions

In a recent systemic review published in Bone Marrow Transplantation, researchers have found associations between graft-versus-host disease (GVHD) and neurological complications (NCs). Hematopoietic cell transplantation (HCT) is approved for treating certain types of blood cancers but can lead to acute and chronic GVHD (aGVHD and cGVHD respectively), which can be life-threatening. Furthermore, studies have demonstrated NCs to develop post-HCT. This study sought to find an association between GVHD and NCs.

 

Inclusion criteria consisted of case reports, case series, clinical trials, and retrospective studies. Excluded studies included systematic reviews, meta-analyses, review articles, and preclinical studies. The NCs explored were seizures, posterior reversible encephalopathy syndrome (PRES), myasthenia gravis (MG), stroke, and peripheral neuropathy (PN). Among NCs investigated, a concurrence of aGVHD and seizures (P < 0.00001); cGVHD and seizures (P = 0.00024); aGVHD and PRES (P = 0.0002); and cGVHD and stroke (P < 0.00001) was observed.

 

The authors suggest the correlation between aGVHD and PRES may be due to septic and systemic inflammatory conditions, which are common for both aGVHD and PRES. The authors further suggest the correlation between cGVHD and stroke could be attributed to post-HCT thrombocytopenia, leading to factor XIII deficiency. Overall, this study provides the first correlations between GVHD and NC, warranting further prospective studies to understand these complications.

 

Source:

Sheikh, M.A., Im, A., Ballen, K. et al. Association of graft-versus-host-disease with neurologic complications: clinical paradigm and future directions. Bone Marrow Transplant (2021). https://doi.org/10.1038/s41409-021-01216-x

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