Central Nervous System Complications and Outcomes after Allogeneic Hematopoietic Stem Cell Transplantation

Vijaya R Bhatt, Vamshi Balasetti, Jagar A. Jasem, Smith Giri, James Olen Armitage, Fausto R. Loberiza, Robert G Bociek, Philip Jay Bierman, Lori J Maness-Harris, Julie Marie Vose, Pierre B Fayad, Mojtaba Akhtari

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Central nervous system complications (CNSC) can be the cause of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). We aimed to determine the incidence of CNSC and its impact on survival. Patients and Methods This retrospective cohort study included patients with hematologic disorders who received allo-HSCT between 2002 and 2011 at the University of Nebraska Medical Center. Results Of the 351 patients identified, 45 developed CNSC (12.8%). The 100-day cumulative incidence of CNSC was 8% (95% confidence interval, 8-15). The most common CNSC included posterior reversible encephalopathy syndrome (40%), stroke or transient ischemic attack (24%), seizures (20%), and infection (9%). The 5-year overall survival was significantly lower among patients with versus without CNSC (14% vs. 44%, P =.0004). In multivariate analysis, the risk of mortality for patients with versus without CNSC was significantly higher (hazard ratio, 1.56; 95% confidence interval, 1.03-2.36; P =.04). Conclusion The occurrence of CNSC after allo-HSCT was associated with reduced survival. Identifying patients at risk, monitoring, early detection, and management of CNSC after allo-HSCT are needed to improve outcomes.

Original languageEnglish (US)
Pages (from-to)606-611
Number of pages6
JournalClinical Lymphoma, Myeloma and Leukemia
Volume15
Issue number10
DOIs
StatePublished - Oct 1 2015

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Hematopoietic Stem Cell Transplantation
Central Nervous System
Survival
Posterior Leukoencephalopathy Syndrome
Confidence Intervals
Mortality
Transient Ischemic Attack
Incidence
Seizures
Cohort Studies
Multivariate Analysis
Retrospective Studies
Stroke
Morbidity
Infection

Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • Central nervous system complications
  • Posterior reversible encephalopathy syndrome
  • Seizure
  • Stroke
  • Survival

ASJC Scopus subject areas

  • Cancer Research
  • Hematology
  • Oncology
  • Medicine(all)

Cite this

Central Nervous System Complications and Outcomes after Allogeneic Hematopoietic Stem Cell Transplantation. / Bhatt, Vijaya R; Balasetti, Vamshi; Jasem, Jagar A.; Giri, Smith; Armitage, James Olen; Loberiza, Fausto R.; Bociek, Robert G; Bierman, Philip Jay; Maness-Harris, Lori J; Vose, Julie Marie; Fayad, Pierre B; Akhtari, Mojtaba.

In: Clinical Lymphoma, Myeloma and Leukemia, Vol. 15, No. 10, 01.10.2015, p. 606-611.

Research output: Contribution to journalArticle

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AU - Giri, Smith

AU - Armitage, James Olen

AU - Loberiza, Fausto R.

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AB - Background Central nervous system complications (CNSC) can be the cause of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). We aimed to determine the incidence of CNSC and its impact on survival. Patients and Methods This retrospective cohort study included patients with hematologic disorders who received allo-HSCT between 2002 and 2011 at the University of Nebraska Medical Center. Results Of the 351 patients identified, 45 developed CNSC (12.8%). The 100-day cumulative incidence of CNSC was 8% (95% confidence interval, 8-15). The most common CNSC included posterior reversible encephalopathy syndrome (40%), stroke or transient ischemic attack (24%), seizures (20%), and infection (9%). The 5-year overall survival was significantly lower among patients with versus without CNSC (14% vs. 44%, P =.0004). In multivariate analysis, the risk of mortality for patients with versus without CNSC was significantly higher (hazard ratio, 1.56; 95% confidence interval, 1.03-2.36; P =.04). Conclusion The occurrence of CNSC after allo-HSCT was associated with reduced survival. Identifying patients at risk, monitoring, early detection, and management of CNSC after allo-HSCT are needed to improve outcomes.

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