Stroke After Bone Marrow Transplantation: Frequency, Etiology, and Outcome
Background and Purpose–Little data exist on the frequency, etiology, and outcome of cerebrovascular complications of bone marrow transplantation (BMT). Methods–We reviewed all patients undergoing BMT at the Fred Hutchinson Cancer Research Center, Seattle, WA (a large referral institution) over three years. We reviewed ICD-9 codes for ischemic stroke, seizure, intracranial hemorrhage, and brain infection. Using standardized forms, we paid detailed attention to: clinical features and demographics, oncological diagnosis, conditioning regimens, neurological history, comorbidities, time from BMT to ictus, cerebrovascular subtype, radiological and pathological features, and outcomes. Results–We identified 36 patients with stroke from 1,245 patients who had BMT (2.9%) over three years. These patients’ median age was 35 (range 5–60, interquartile 25–45) years. The most common causes of stroke were intracranial hemorrhage related to thrombocytopenia (38.9%) and infarction or hemorrhage secondary to fungal infection (30.6%). Twenty-five patients (69.4%) died from their stroke; none survived without disability. Using a logistic regression model, neither demographic (e.g., age, gender) nor clinical (e.g., oncological diagnosis, type of BMT, time of stroke after BMT) factors predicted outcome. Conclusions–Stroke occurs relatively frequently after BMT (almost 3% incidence), has a relatively high frequency of infection-triggered events, has a neurological outcome not easily predicted from available data, and is often fatal.