Transplant-related intracranial hemorrhage occurred in 4.7% of pediatric thalassemia major patients after bone marrow transplant and was associated with significantly worse overall survival (51% vs. 88%), disease-free survival (37% vs. 76%), and higher transplant-related mortality, with age at transplant as the main positive predictor.
The incidence of transplant-related intracranial hemorrhage (ICH) in pediatric thalassemia major patients after bone marrow transplant was 4.7%.
ICH presented predominantly with headache and hypertension, most commonly in the early post-transplant period.
Overall survival and disease-free survival were significantly worse in patients who developed ICH compared to those who did not.
Transplant-related mortality was higher in patients who developed ICH than in patients who did not.
Age at time of bone marrow transplant was identified as the main positive predictor of developing ICH after BMT.
This research examined how often bleeding in the brain (intracranial hemorrhage, or ICH) occurs in children with thalassemia major who receive a bone marrow transplant, and what happens to those children afterward. Looking at 595 children treated across four centers in South Asia over 13 years, the researchers found that about 1 in 20 children (4.7%) developed this serious complication. It most often appeared within the first month after transplant and typically came with symptoms like headache and high blood pressure. Children who developed brain bleeding had dramatically worse outcomes than those who did not. Their overall survival rate was 51% compared to 88% in children without ICH, and their disease-free survival was 37% compared to 76%. Transplant-related deaths were also more common in the ICH group. The researchers found that older age at the time of transplant was the main factor that predicted which children were more likely to develop this complication. This research suggests that intracranial hemorrhage is a serious but relatively uncommon complication of bone marrow transplantation in children with thalassemia major, and that it substantially worsens survival outcomes. The finding that older age at transplant increases risk may support the existing clinical rationale for performing transplants earlier in life when possible. Early recognition of warning signs like headache and high blood pressure in the first month after transplant could be important for prompt diagnosis and management.
Batool A, Khalid S, Ainur Z, Naghmi N, Niazi M, Reddy M, et al.. (2026). Incidence, Risk Factors, and Outcome of Transplant-Related Intra-Cranial Hemorrhage in Pediatric Thalassemia Major Patients.. Pediatric transplantation. https://doi.org/10.1111/petr.70350