Analysis of the clinical features of central nervous system complications after allogeneic hematopoietic stem cell transplantation
Objective To explore the risk factors for central nervous system(CNS)complications after allogeneic hematopoietic stem cell transplantation(allo-HSCT)and their impact on patient survival.Methods The clinical data of 171 patients who underwent allo-HSCT in the Affiliated Hospital of Xuzhou Medical University from April 2018 to December 2021 were retrospectively analyzed.The clinical data of the above patients who presented CNS complications were statistically described.The risk factors for CNS complications were analyzed,and survival analysis was performed.Results CNS complications occurred in 19 of 171 allo-HSCT patients,with a median time to occurrence of 118(3-826)days,including 9 cases of cerebrovascular complications(5 cases of cerebral hemorrhage and 4 cases of cerebral infarction),2 cases of central relapses,2 cases of central infection,1 case of transplantation associated thrombotic microangiopathy(TA-TMA),1 case of metabolic encephalopathy,1 case of chronic central nervous system graft versus host disease(CNS-cGVHD),and 3 cases with unclear etiology.Clinical manifestations included headache,seizures and impaired consciousness.The results of univariate analysis showed that the reconstruction of megakaryocyte and granulomatous lineages were influencing factors for CNS complications after allo-HSCT(P<0.05).According to multivariate analysis,non-reconstruction of megakaryocyte lineage was a risk factor for the development of CNS complications after allo-HSCTT(P<0.05).The survival analysis indicated that patients with CNS complications had significantly lower 1-year and 2-year overall survival(OS)than those without CNS complications(P<0.001).They also showed decreases in 1-year and 2-year disease-free survival(DFS),but increases in 1-year and 2-year non-recurrent mortality(NRM),compared with those without CNS complications(P<0.001).Conclusions Non-reconstruction of megakaryocyte lineage is the independent risk factor for CNS complications after allo-HSCT.Patients with CNS complications have significantly decreased OS and DFS compared with those without CNS complications,and patients with CNS complications often have a poor prognosis.
NETL
NSTL
万方数据
维普
