Clinical Analysis Of Central Nervous System Complications After Allo-HSCT

Part ?Clinical features,risk factors and outcomes of Central Nervous System Complications after allo-HSCT in adultsObjective To summarize the clinical features,risk factors and its impact on survival of central nervous system complications(CNSCs)after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in adult patients.Methods We retrospectively analyzed clinical data of 810 consecutive adult patients who underwent allo-HSCT in the First Affiliated Hospital of Soochow University between January 2013 and December 2015.Results To the end of follow-up,a total of 126 patients(15.6%)developed CNSCs.The estimated CIR of CNSCs at 100 days,1 years,and 3 years after allo-HSCT,were9.38%,13.46% and 16.56%,respectively.Most of CNSCs(60.3%,76 of 126)occurred within 100 days after allo-HSCT.Cerebrovascular events were the most common CNSCs after allo-HSCT(23.8%),followed by drug-related neurotoxicity(22.2%),metabolic encephalopathy(15.1%),infectious disease(14.3%),CNS relapse of underlying disease(14.3%),immune-mediated encephalopathy(7.9%),and unidentified encephalopathy(2.4%).Seizure(50.8%)was the most frequent neurologic symptom,followed by altered levels of consciousness(20.6%),fever and/or headache(15.2%),abnormality of cranial nerve(such as ophthalmoplegia,visual fields defect,or facial palsy;8.7%),and others(such as memory decline,language barrier,and so on;3.2%).Patients with 0-1 grade a GVHD were chosen as the control group,stratified analyses demonstrated that HLA-mismatched patients with 2-4 grade a GVHD(hazard ratio [HR],2.65;95% CI,1.68-4.17)were more likely to suffer from CNSCs than those who recepted HLA-matched allo-HSCT(HR,0.99;95% CI,0.52-1.87;P=0.015 for interaction),and female patients with severe a GVHD(HR,2.79;95% CI,1.66-4.68)were also more prone to CNSCs than male patients(HR,1.36;95% CI,0.85-2.18;P=0.040 for interaction).The 3-year overall survival(OS)was significantly lower among patients with than without CNSCs(25% vs.66%,P < 0.001).Conclusions CNSCs are common complications after allo-HSCT and sufficently reduced overall survival.More attention should be paid to HLA-mismatched and female patients with severe a GVHD after allo-HSCT.Part ? Central nervous system complications after allo-HSCT in children:clinical features,risk factors and outcomesObjective To summarize the clinical features,risk factors and its impact on survival of central nervous system complications(CNSCs)after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in pediatric patients.Methods We retrospectively analyzed clinical data of 169 consecutive pediatric patients who underwent allo-HSCT in the First Affiliated Hospital of Soochow University between January 2013 and December 2015.Results Of 169 patients(105 male and 64 females)with a median age of 13(1 to 17)years old,CNSCs occurred in 39 patients,the total incidence of CNSCs was 27.6%,with a median time of 33(1 to 582)days.CNSCs primarily included: 14(35.9%)Drug-related neurotoxicity,7(17.9%)immune-mediated encephalopathy,6(15.4%)Cerebrovascular events,4(10.3%)infectious disease(10.3%),4(10.3%)CNS relapse of underlying disease and metabolic encephalopathy,and so on.The estimated CIR of CNSCs at 100 days and 1years after allo-HSCT,were 17.75% and 21.89%,respectively.In multivariate analysis,acute GVHD > grade 2 was identified as an independent risk factor for CNSCs.The 3-year overall survival rate was significantly lower in patients with CNSCs than without(48% vs.69%,P<0.001).In multivariate analysis,the risk of mortality for patients with CNSCs than without was significantly higher(HR=2.79;95% CI,1.52~5.11;P<0.001).Conclusions CNSCs are frequent among children undergoing allo-HSCT and sufficently reduced OS of patients.More attention should be paid to recipients with severe a GVHD after allo-HSCT.