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

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)722-730
Number of pages9
JournalEuropean Journal of Haematology
Volume105
Issue number6
DOIs
Publication statusPublished - Dec 1 2020
Externally publishedYes

Keywords

  • allogeneic transplantation
  • central nervous system
  • complications

ASJC Scopus subject areas

  • Hematology

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