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Major central nervous system complications after allogeneic stem cell transplantation: A large retrospective study on 888 consecutive adult patients
Author(s) -
Mannina Daniele,
Berneking Laura,
Both Anna,
Timm Wiebke,
Urbanowicz Tatiana,
Wolschke Christine,
Ayuketang Ayuk Francis,
Fischer Nicole,
Fiehler Jens,
Grzyska Ulrich,
Rösner Sabine,
Choe ChiUn,
Kröger Nicolaus,
Christopeit Maximilian
Publication year - 2020
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13489
Subject(s) - medicine , complication , incidence (geometry) , cumulative incidence , transplantation , central nervous system , retrospective cohort study , surgery , physics , optics
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 1 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, psychiatric; and 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. In particular, the situations of unclear neurological complications need to be clarified by intensive research.