Clinical lymphoma, myeloma & leukemia · 2015
Central Nervous System Complications and Outcomes After Allogeneic Hematopoietic Stem Cell Transplantation.
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Bhatt Vijaya Raj, Balasetti Vamshi, Jasem Jagar A, Giri Smith, Armitage James O, Loberiza Fausto R, Bociek R Gregory, Bierman Philip J, Maness Lori J, Vose Julie M, Fayad Pierre, Akhtari Mojtaba
Аннотация
BACKGROUND: Central nervous system complications (CNSC) can be the cause of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). We aimed to determine the incidence of CNSC and its impact on survival.
PATIENTS AND METHODS: This retrospective cohort study included patients with hematologic disorders who received allo-HSCT between 2002 and 2011 at the University of Nebraska Medical Center.
RESULTS: Of the 351 patients identified, 45 developed CNSC (12.8%). The 100-day cumulative incidence of CNSC was 8% (95% confidence interval, 8-15). The most common CNSC included posterior reversible encephalopathy syndrome (40%), stroke or transient ischemic attack (24%), seizures (20%), and infection (9%). The 5-year overall survival was significantly lower among patients with versus without CNSC (14% vs. 44%, P = .0004). In multivariate analysis, the risk of mortality for patients with versus without CNSC was significantly higher (hazard ratio, 1.56; 95% confidence interval, 1.03-2.36; P = .04).
CONCLUSION: The occurrence of CNSC after allo-HSCT was associated with reduced survival. Identifying patients at risk, monitoring, early detection, and management of CNSC after allo-HSCT are needed to improve outcomes.
PATIENTS AND METHODS: This retrospective cohort study included patients with hematologic disorders who received allo-HSCT between 2002 and 2011 at the University of Nebraska Medical Center.
RESULTS: Of the 351 patients identified, 45 developed CNSC (12.8%). The 100-day cumulative incidence of CNSC was 8% (95% confidence interval, 8-15). The most common CNSC included posterior reversible encephalopathy syndrome (40%), stroke or transient ischemic attack (24%), seizures (20%), and infection (9%). The 5-year overall survival was significantly lower among patients with versus without CNSC (14% vs. 44%, P = .0004). In multivariate analysis, the risk of mortality for patients with versus without CNSC was significantly higher (hazard ratio, 1.56; 95% confidence interval, 1.03-2.36; P = .04).
CONCLUSION: The occurrence of CNSC after allo-HSCT was associated with reduced survival. Identifying patients at risk, monitoring, early detection, and management of CNSC after allo-HSCT are needed to improve outcomes.
Предметные рубрики MeSH
AdolescentAdultAgedChildChild, PreschoolFemaleHematopoietic Stem Cell TransplantationHumansInfantLeukemia, Myeloid, AcuteMaleMiddle AgedMultivariate AnalysisPosterior Leukoencephalopathy SyndromeProportional Hazards ModelsRetrospective StudiesRisk FactorsSeizuresStrokeTransplantation, HomologousTreatment OutcomeYoung Adult