| Purpose:To investigate the clinical features,risk factors and impact on overall prognosis of Central nervous system complications(CNSCs)associated with Allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:The clinical data of 244 pediatric patients who underwent allo-HSCT in the Department of Pediatrics of Southern Hospital of Southern Medical University from January 2019 to December 2021 were retrospectively analyzed,including 156(63.9%)males and 88 females(36.1%),with a median age of 7 years(8.4 months to 17 years)for all children.Primary diseases included 131 cases of thalassemia,39 cases of acute myeloid leukemia,24 cases of aplastic anemia,16 cases of acute lymphoblastic leukemia,8 cases of juvenile granulomye-monocytic leukemia,4 cases of eczema thrombocytopenia with immune deficiency syndrome(WAS),as well as rare diseases such as myelodysplastic syndrome,chronic active EBV infection,hemophagocytic syndrome,and osteopetrosis.The clinical characteristics,incidence and prognosis of CNSCs mainly characterized by convulsive seizures were statistically analyzed.Results:We divided the children into the tic group and the normal group according to the presence or absence of allo-HSCT-related tic seizures,and there were statistically significant differences in underlying disease and survival time between the two groups.By the end of follow-up in December 2022,a total of 16 neurological complications(times)mainly seizures had occurred,with a total incidence of 6.5%.The median time for tic seizures was 95 days after allo-HSCT,and all children had tic seizures within 1 year of transplantation.Generalized seizures are most common and present with impaired consciousness,binocular gaze,breathlessness,closed teeth,crooked corners of the mouth,foaming at the mouth,stiffness or shaking of the extremities,absence seizures or absence seizures with rigidity.There are also local seizures that present as unilateral limb clonic seizures.In addition to seizures,these patients are accompanied by non-specific manifestations such as headache,blurred vision,vomiting,and fever.Causes of convulsive seizures include:central nervous system infection,transplantassociated thrombotic microangiopathy(TA-TMA),calcineurin inhibitor(CIN)toxicity,hypoglycemia,electrolyte abnormalities,intracranial hemorrhage(ICH),recurrence of AML center,etc.After aggressive causative and symptomatic treatment,75%of the children achieved good outcomes,12.5%had long-term neurological complications,and 12.5%died due to CNSCs.The median survival time was 547 days in the tic group lower than 638 days in the non-tic group.After aggressive treatment,most children with convulsions have a good prognosis.Conclusion:Central nervous system complications are rare complications of allogeneic hematopoietic stem cell transplantation in children,and convulsive seizures are the most common manifestations,with an incidence of 6.5%.The use of thiotepa(TT),pretreatment regimen of cyclophosphamide post(PTCy)or cyclophosphamide and fludarabine post(PTCy+Flu),Chimeric status was closely related to seizures,and the age,sex,underlying diseases,HLA compatibility of the donor,and pretreatment regimen of transplanted children were not high-risk factors for tic seizures,and the median survival time of the tic group was significantly lower than that in the non-tic group.The main cause of allo-HSCT-associated seizures is cerebrovascular events in infectious as well as noninfectious factors.Most children with tics have a good prognosis,and cerebrovascular events are the most common cause of tic-related death.The long interval between diagnosis and transplantation of underlying diseases and late platelet implantation are risk factors for poor prognosis in children with seizures. |
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