当前位置： SCI文献检索 > JOURNAL OF NEUROLOGY期刊下所有文献 > Neurological adverse events post allogeneic hematopoietic cell transplantation: major determinants of morbidity and mortality.

Neurological adverse events post allogeneic hematopoietic cell transplantation: major determinants of morbidity and mortality.

Abstract：

BACKGROUND:Despite advances in the field, diagnosis and management of the wide spectrum of neurological events post allogeneic hematopoietic cell transplantation (alloHCT) remain challenging. Therefore, we investigated their incidence, diagnosis, management and long-term prognosis in alloHCT recipients. METHODS:We retrospectively recorded data from consecutive alloHCT recipients with or without neurological complications in our center. RESULTS:Among 758 alloHCT recipients, 127 (16.8%) presented with neurological complications. Complications developed in central nervous system (89.7%) during the late post-transplant period. Neurological adverse events included a wide spectrum of infectious and non-infectious etiologies. With a median follow-up of 11.4 months, incidence of chronic graft-versus-host disease (GVHD) was 52.8%, relapse mortality 48.6%, transplant-related mortality 39.1% and 5-year overall survival (OS) 25.8% in patients with neurological complications. Timing of appearance of neurological complications, early or late, was associated only with acute and chronic graft-versus-host-disease/GVHD. Independent pre-transplant risk factors of neurological complications in the multivariate model were unrelated or alternative donors, ALL diagnosis and non-myeloablative conditioning. In multivariate analysis of post-alloHCT events, favorable OS was independently associated with resolution of neurological syndromes, absence of chronic GVHD and sibling transplantation. In our cohort, 10-year OS was significantly lower in patients with neurological complications and independently associated with acute and chronic GVHD, relapse, fungal and bacterial infections and neurological complications. CONCLUSIONS:Our large study with long-term follow-up highlights the wide spectrum of neurological complications in alloHCT. Accurate recognition is required for adequate management, a major determinant of survival. Thus, long-term increased awareness and collaboration between expert physicians is warranted.

journal_name

J Neurol

journal_title

Journal of neurology

authors

Sakellari I,Gavriilaki E,Papagiannopoulos S,Gavriilaki M,Batsis I,Mallouri D,Vardi A,Constantinou V,Masmanidou M,Yannaki E,Smias C,Geroukis T,Kazis D,Kimiskidis V,Anagnostopoulos A

doi

10.1007/s00415-019-09372-3

subject

Has Abstract

pub_date

2019-08-01 00:00:00

pages

1960-1972

issue

eissn

0340-5354

issn

1432-1459

pii

10.1007/s00415-019-09372-3

journal_volume

266

pub_type

杂志文章

在线工具

Neurological adverse events post allogeneic hematopoietic cell transplantation: major determinants of morbidity and mortality.