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<p>CNS complications (CNSC) may occur in a significant proportion of patients after allogeneic haematopoietic cell transplantation (allo-HCT). They can be differentiated into infectious and non-infectious CNSC, such as vascular pathologies (e.g., bleeding, stroke), drug-related abnormalities, and CNS relapse of the underlying malignancy. Initiation of prompt and adequate diagnostics – mainly neuroimaging and cerebrospinal fluid (CSF) analyses – and treatment are crucial to improve the prognosis. Here, we report on the epidemiology, outcome, and neuroimaging of CNSC after allo-HCT. We also provide an overview of the special considerations for children with these complications. These findings and recommendations were developed during a multidisciplinary EBMT harmonisation workshop. Novel diagnostics, such as CSF next-generation sequencing (NGS) and special MRI sequences, are emerging and may improve the accuracy of diagnosis for selected CNSC. The prognosis of post-transplant CNSC is heterogeneous, with drug-related CNSC mainly having a favourable prognosis, while the outcome of CNS bleeding, CNS leukaemia, and cerebral fungal disease is still frequently dismal. A high level of awareness is crucial in the clinical routine – especially in distinct subgroups such as paediatrics – besides the development of novel algorithms, diagnostics, and treatment approaches to improve the outcome.</p>

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Central nervous system complications after allogeneic haematopoietic cell transplantation: best practice recommendations from the EBMT practice harmonisation and guidelines committee on epidemiology, outcome and neuroimaging

  • 期刊论文

  • 发表日期：

    2026年5月13日

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  • Martin Schmidt-Hieber,
  • Roser Velasco,
  • Olaf Penack,
  • Dina Averbuch,
  • Aitana Balaguer-Roselló,
  • Francesco Baccelli,
  • Luis Bataller,
  • Simone Cesaro,
  • Chiara Briani,
  • Rafael de la Cámara,
  • Petra Huehnchen,
  • Thushan de Silva,
  • Alberto Mussetti,
  • Per Ljungman,
  • Zinaida Perić,
  • Malgorzata Mikulska,
  • Alexey Polushin,
  • David Navarro,
  • Albert Pons-Escoda,
  • Dionysios Neofytos,
  • Hélène Schoemans,
  • José Luis Piñana,
  • Francesco Onida,
  • Annalisa Ruggeri,
  • Isabel Sanchez-Ortega,
  • Ibrahim Yakoub-Agha,
  • Jan Styczynski

摘要

CNS complications (CNSC) may occur in a significant proportion of patients after allogeneic haematopoietic cell transplantation (allo-HCT). They can be differentiated into infectious and non-infectious CNSC, such as vascular pathologies (e.g., bleeding, stroke), drug-related abnormalities, and CNS relapse of the underlying malignancy. Initiation of prompt and adequate diagnostics – mainly neuroimaging and cerebrospinal fluid (CSF) analyses – and treatment are crucial to improve the prognosis. Here, we report on the epidemiology, outcome, and neuroimaging of CNSC after allo-HCT. We also provide an overview of the special considerations for children with these complications. These findings and recommendations were developed during a multidisciplinary EBMT harmonisation workshop. Novel diagnostics, such as CSF next-generation sequencing (NGS) and special MRI sequences, are emerging and may improve the accuracy of diagnosis for selected CNSC. The prognosis of post-transplant CNSC is heterogeneous, with drug-related CNSC mainly having a favourable prognosis, while the outcome of CNS bleeding, CNS leukaemia, and cerebral fungal disease is still frequently dismal. A high level of awareness is crucial in the clinical routine – especially in distinct subgroups such as paediatrics – besides the development of novel algorithms, diagnostics, and treatment approaches to improve the outcome.