Children at Risk After Stem Cell Transplant

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Children at Risk After Stem Cell Transplant
January 06, 2003 05:59:16 PM PST, Reuters
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A stem cell transplant can be lifesaving for children with blood cancers like leukemia and some genetic diseases, but some children experience severe, life-threatening neurological complications after the treatment, researchers in Italy report.

Dr. Maura Faraci and colleagues reviewed the cases of 272 children who had had a stem cell transplant at the G. Gaslini Children's Research Institute in Genova. Severe neurological complications, including infections, seizures and bleeding in the brain, occurred in 14% of children anywhere from five days to nearly nine years after the treatment.

Overall, neurological complications were to blame for nearly 9% of the deaths after transplant.

A report on the findings appears in the December 24th issue of the journal Neurology.

All the children received a transplant of a type of cell found in blood and bone marrow called a hematopoietic stem cell. Such stem cells have the capability to form all different types of blood and immune system cells.

Although all the children received stem cells, each child's risk of neurological complications varied, depending on several factors.

For instance, the researchers found that the source of the stem cells affected the risk of complications. For children who received stem cells that had been taken from their own body, the risk of having at least one severe neurological complication during a three-year period after treatment was relatively low, only about 2%.

For children who received cells from a relative, the risk was 15%. The risk was highest, 39% over a three-year period, in children who received cells donated by a non-relative.

Besides the source of the stem cells, the occurrence of a complication called graft-versus-host disease (GVHD) increased the risk of neurological complications. During GVHD, the transplanted cells may attack the patient's body. Immune-suppressing drugs can reduce the risk of GVHD, but they do not always work and can leave patients vulnerable to infections.

In addition, the study found that children who had undergone a procedure called total body irradiation before receiving a transplant were more likely to experience severe neurological complications.

SOURCE: Neurology 2002;59:1895-1904.