Myrna R. Rosenfeld, MD, PhD Penn Neurological Institute, University of Pennsylvania Medical Center, 2 Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Curr Treat Options Neurol. 2007 Jul;9(4):308-14. doi: 10.1007/s11940-007-0016-3.
Transplantation of bone marrow or peripheral blood stem cells is increasingly being used to treat a variety of oncologic disorders. These procedures are associated with a large spectrum of neurologic complications that significantly contribute to patient morbidity and mortality. These complications may arise at any time during and after the transplantation process and are particularly common in patients requiring chronic immunosuppression. The most frequent complications are infections and cerebrovascular or metabolic events, and toxicity from radiation or chemotherapy. Because of the unique circumstances and treatments involved in each step of the transplantation process, there is a higher incidence of some neurologic complications during discrete time periods, and an awareness of the temporal relationship of the neurologic disorder to the transplantation process facilitates diagnosis. With the exception of post-transplant lymphoproliferative disorder, in which reduced immunosuppression may be an effective therapeutic strategy, therapies are often the same as in the nontransplant patient. Complications of therapy can arise because of the presence of multiple comorbidities and medication interactions. Anticipation of common opportunistic infections and appropriate use of prophylactic medications can significantly reduce the incidence of infectious complications.
骨髓或外周血干细胞移植越来越多地用于治疗各种肿瘤疾病。这些操作与广泛的神经并发症相关，显著增加了患者的发病率和死亡率。这些并发症可能发生在移植过程中和移植后任何时候，在需要慢性免疫抑制的患者中尤其常见。最常见的并发症是感染、脑血管或代谢事件，以及来自辐射或化疗的毒性。由于移植过程中每个步骤涉及的特殊情况和治疗方法，在不同的时间段内发生某些神经并发症的几率更高，了解神经疾病与移植过程的时间关系有助于诊断。除了移植后淋巴组织增生性疾病外，降低免疫抑制可能是一种有效的治疗策略，其他治疗方法通常与非移植患者相同。由于存在多种合并症和药物相互作用，治疗并发症可能会出现。预期常见的机会性感染并适当使用预防性药物可以显著降低感染并发症的发生率。
