Central nervous system complications in renal transplant recipients: Report of 68 cases

Objective: To observe the central nervous system (CNS) complications among 1083 consecutive renal transplant (RT) recipients. Methods: Systemic analyses of the incidence, time of onset and clinical outcome of CNS complications were conducted in 1083 patients receiving cadaveric RT in Nanfang Hospital during Jan 1992 to Dec 1999. Results: Various CNS complications occurred in a total of 68 RT recipients (6. 28%, 68/1083) with a mortality of (1.29%, 14/1083). Of all the 1 083 recipients enrolled in this study,diffuse encephalopathy occurred in 31 cases (2.86%), cerebrovascular accidents in 17 (1.56%), seizure in 11 (1.02%) and CNS infection in 9 (0. 83%). Immusuppressive agents was the major cause for diffuse encephalopathy (93.5 %, 29/31), and cerebrovascular accidents were associated with a mortality rate of 70. 5%(12/17) and CNS infection with a mortality rate of 22. 22% (2/9). Most of the complications took place within the first month after RT, especially the first 2 weeks, but the majority of CNS infection occurred 1 year after RT. Conclusion: About 6% of renal transplant recipients develop CNS complications that result in a mortality of 1. 29%, which require early diagnosis and vigorous treatment. Diffuse encephalopathy and cerebrovascular accidents are the two most common CNS complications, and immunosuppressive agents play a important role in the occurrence of encephalopathy. Most of the CNS complications occurred early after RT, but CNS infections may occur rather late, and cerebrovascular accidents and CNS infection are the two major causes of death.

Neurological complications of hematopoietic cell transplantation in children and adults

Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched donor（allogeneic） or from the patient（autologous）. Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease（Gv HD）. Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, Gv HD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT：（1） early complications（in the first month）-related to harvesting of stem cells, during conditioning（drug toxicity, posterior reversible encephalopathy syndrome）, related to pancytopenia,（2） intermediate phase complications（second to sixth month）-central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus,（3） late phase complications（after sixth month）-neurological complications of Gv HD, second neoplasms and relapses of the original disease.

Subcutaneous panniculitis-like T-cell lymphoma invading central nervous system in long-term clinical remission with lenalidomide:A case report

BACKGROUND Subcutaneous panniculitis-like T-cell lymphoma(SPTCL)involvement in the central nervous system(CNS)is particularly rare.SPTCL with CNS involvement has an exceedingly poor prognosis,and no optimum therapeutic method has been discovered.To the best of our knowledge,this is the first reported case of SPTCL invading the CNS achieving long-term remission with lenalidomide maintenance therapy.CASE SUMMARY A 63-year-old man diagnosed with SPTCL was admitted to the hospital with severe headache for 15 d after four cycles of chemotherapy.Subsequent to the treatment,the patient developed CNS involvement.Craniotomy biopsy was pathologically diagnosed as CNS T-cell lymphoma,and two courses of chemotherapy were performed postoperatively.Due to the intolerance of the side effects of chemotherapeutic drugs,the patient received lenalidomide instead.The magnetic resonance imaging of the head at the 8 mo follow-up indicated no signs of recurrence,and the vital signs were stable.CONCLUSION Lenalidomide deserves further investigation as a targeted drug for SPTCL cases involving the CNS.