Neurologic complications after allogeneic hematopoietic stem cell transplantation: risk factors and impact

被引:37
|
作者
Dowling, M. R. [1 ,2 ,3 ,4 ]
Li, S. [5 ]
Dey, B. R. [6 ]
McAfee, S. L. [6 ]
Hock, H. R. [6 ]
Spitzer, T. R. [6 ]
Chen, Y-B [6 ]
Ballen, K. K. [7 ]
机构
[1] Walter & Eliza Hall Inst Med Res, Immunol Div, Parkville, Vic, Australia
[2] Univ Melbourne, Dept Med Biol, Parkville, Vic, Australia
[3] Royal Brisbane & Womens Hosp, Herston, Qld, Australia
[4] Univ Queensland, Sch Med, Brisbane, Qld, Australia
[5] Dana Farber Canc Inst, Boston, MA 02115 USA
[6] Massachusetts Gen Hosp, Canc Ctr, Boston, MA 02114 USA
[7] Univ Virginia, Canc Ctr, Univ Virginia Hlth Syst, Dept Med,Stem Cell Transplant Program, 1215 Lee St, Charlottesville, VA 22903 USA
基金
英国医学研究理事会;
关键词
BONE-MARROW-TRANSPLANTATION; REVERSIBLE ENCEPHALOPATHY SYNDROME; CORD BLOOD TRANSPLANTATION; PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY; NERVOUS-SYSTEM COMPLICATIONS; HIGH-DOSE CHEMOTHERAPY; LIMBIC ENCEPHALITIS; COMPETING RISK; CYCLOSPORINE-A; TACROLIMUS;
D O I
10.1038/bmt.2017.239
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
Neurologic complications (NCs) may be a significant source of morbidity and mortality after hematopoietic cell transplantation (HCT). We performed a retrospective study of 263 consecutive patients undergoing allogeneic HCT for hematological malignancies to determine the incidence, risk factors and clinical impact of NCs in the first 5 years after HCT. We determined the incidence of central nervous system (CNS) infection, intracranial hemorrhage, ischemic stroke, metabolic encephalopathy, posterior reversal encephalopathy syndrome, seizure and peripheral neuropathy. In all, 50 patients experienced 63 NCs-37 early (<= day + 100), 21 late (day + 101 to 2 years) and 5 very late (2 to 5 years). The 1- and 5-year cumulative incidences of all NCs were 15.6% and 19.2%, respectively, and of CNS complication (CNSC; all of the above complications except peripheral neuropathy) were 12.2 and 14.5%. Risk factors for CNSC were age (hazard ratio (HR) = 1.06 per year, P = 0.0034), development of acute GvHD grade III-IV (HR = 2.78, P=0.041), transfusion-dependent thrombocytopenia (HR = 3.07, P = 0.025) and delayed platelet engraftment (> 90th centile; HR = 2.77, P = 0.043). CNSCs negatively impacted progression-free survival (HR = 2.29, P = 0.0001), overall survival (HR = 2.63, P < 0.0001) and non-relapse mortality (HR = 8.51, P < 0.0001). NCs after HCT are associated with poor outcomes, and usually occur early after HCT.
引用
收藏
页码:199 / 206
页数:8
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