Neurological Complications in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Single-Center Study

Objective: Neurological complications following allogeneic hematopoietic stem cell transplantation (allo-HSCT) are rare but serious events that significantly impact morbidity and mortality. This study aims to evaluate the incidence, clinical spectrum, and associated risk factors of neurological complications in patients who underwent allo-HSCT at a single center. Methods: We retrospective analyzed 108 patients who underwent allo-HSCT between January 2022 and December 2024. Patients were categorized by transplant type: myeloablative related donor (n=48), myeloablative unrelated donor (n=36), and haploidentical transplant (n=24). Neurological complications were observed in 18 patients (16.7%) and analyzed in terms of demographics, transplant type, hematologic diagnosis, conditioning regimen, infections, GVHD status, and outcomes. Results: The mean age of affected patients was 52.56 years (range 20–71), with equal gender distribution. Neurological complications developed between day 15 and day 395 post-transplant (mean: day 200). CMV positivity was detected in 14 of 17 patients with neurological complications. Acute GVHD was present in 11 patients and chronic GVHD in 5 patients. Statistical analysis revealed a significant association between neurological complications and CMV positivity (p=0.000), acute GVHD (p=0.014), and chronic GVHD (p=0.009). Ten patients died, with causes including disease progression, severe GVHD, CMV encephalitis, and hemophagocytic syndrome. Conclusion: Neurological complications post-allo-HSCT are diverse and often fatal. CMV infection, acute and chronic GVHD are significant risk factors. Early diagnosis and multidisciplinary management are essential to improve outcomes.