Major central nervous system complications after allogeneic stem cell transplantation: a large retrospective study on 888 consecutive adult patients

Daniele Mannina, Laura Berneking, Anna Both, Wiebke Timm, Tatiana Urbanowicz, Christine Wolschke, Francis Ayuketang Ayuk, Nicole Fischer, Jens Fiehler, Ulrich Grzyska, Sabine Rösner, Chi-Un Choe, Nicolaus Kröger, Maximilian Christopeit
European Journal of Haematology 2020 July 13

OBJECTIVES: Major complications affecting the central nervous system (CNS) present a challenge after allogeneic stem cell transplantation (allo-SCT).

METHODS: Incidence, risk factors, and outcome were retrospectively analyzed in 888 patients in a monocentric study.

RESULTS: Cumulative incidence (CI) of major CNS complications at one year was 14.8% (95%CI 12.3%-17.2%). Median follow-up is 11 months. CNS complications were documented in 132 patients: in 36 cases classified metabolic, 26 drug-related neurotoxicity (14 attributed to cyclosporine A, 4 to antilymphocyte globulin), 11 cerebrovascular (ischemic n=8, bleeding n=3), 9 infections, 9 malignant. The cause of CNS symptoms remained unclear for 37 patients (28%). Multivariate analysis demonstrated an association of CNS complication with patient age (p<.001). The estimated OS of patients with any CNS complication was significantly lower than in patients without neurological complications (p<.001), and the CI of non-relapse mortality (NRM) was higher for patients with CNS complication (p<.001). A significant negative impact on survival can only be demonstrated for metabolic CNS complications and CNS infections (NRM, p<.0001 and p=.0003, respectively), and relapse (p<.0001).

CONCLUSION: CNS complications after allo-SCT are frequent events with a major contribution to morbidity and mortality. Especially the situations of unclear neurological complications need to be clarified by intensive research.

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