Wernicke encephalopathy in the bone marrow transplantation clinic: diagnostic and therapeutic aspects for hematologists, neurologists, nutritionists

Introduction. Hematopoietic stem cell transplantation (HSCT) is a complex method characterized by high-dose chemotherapy exposure, a long period of pancytopenia and the use of immunosuppressants, which can cause undesirable complications, including those involving the nervous system. The most common complications with damage to the nervous system in oncohematology are toxic reactions, infectious, cerebrovascular diseases, and dysmetabolic conditions. Among deficiency states, as a result of thiamine deficiency against the background of impaired appetite and gastrointestinal toxicity syndrome, the development of Wernicke encephalopathy (WE) can be expected. The objective was to detail risk factors for WE in oncohematology and to increase alertness among physicians of various specialties regarding the likelihood of developing this complication during cytostatic, immune therapy and HSCT. Methods and materials. In the framework of the retro- and prospective study, the transplantation activity of the Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation from 2018 to 2024 was analyzed. During the study period, 2081 HSCT were performed, among which 5 cases of WE were identified. Results. The risk factors for WE in the study group of patients are presented. Data on the differential diagnosis of WE with other diseases characteristic of the post-transplant period of allo-HSCT are collected. Literature data on the detection rate, clinical, neuroimaging, morphological features of WE in the group of patients undergoing HSCT were analyzed. Recommendations were given for the implementation of nutritional therapy in the oncohematology center, as well as for emergency therapy of thiamine deficiency. Conclusion. In the structure of oncohematological centers, especially those specializing in the implementation of HSCT, the optimal step is the creation of an interdisciplinary service – laboratory, hematological, neurological, nutritional – focused on the nuances of specific complications during antitumor treatment.