Neurological complications (NCs) represent a diagnostic and clinical challenge in allogeneic hematopoietic stem cell transplant (alloHSCT) patients. We retrospectively analyzed NC incidence, etiology, timing, characteristics, outcome, and long-term effects in 2384 adult patients transplanted in seven Italian institutions between January 2007 and December 2019. Ninety-three (3.9%) patients were affected by 96 NCs that were infectious (29.2%), immune/inflammatory (26%), drug-related (12.5%), cerebrovascular (5.2%), metabolic (3.1%), related to central nervous system disease relapse (11.5%) and malignancy (3.1%), or undefined (9.4%). Six patients (6.4%) had neurological manifestations of chronic graft-versus-host disease (GVHD). NCs occurred on average at day +128 (from −5 to +4063). Early (< day +120) and late NCs had similar frequencies (46.9% vs 53.1%, p = 0.39). Thirty-one patients (33.3%) were affected by acute or chronic GVHD at the NC onset. With a median follow-up of 25.4 (0.4–163) months, the overall mortality due to NCs was 22.6%. The median time between NC onset and death was 36 (1–269) days. Infectious NCs were the main cause (61.9%) of NC-related mortality. A persistent neurological impairment occurred in 20.4% patients, 57.9% of whom being affected by immune/inflammatory NCs. This study highlights the rare, yet severe impact of alloHSCT-associated NCs on patient survival and long-term functional ability.

Neurological complications in adult allogeneic hematopoietic stem cell transplant patients: Incidence, characteristics and long-term follow-up in a multicenter series / Wieczorek, M.; Mariotto, S.; Ferrari, S.; Mosna, F.; Mico, M. C.; Borghero, C.; Dubbini, M. V.; Malagola, M.; Skert, C.; Andreini, A.; De Marco, B.; Polo, D.; Tfaily, A.; Krampera, M.; Grassi, A.; Candoni, A.; Ranzato, F.; Volonghi, I.; Quatrale, R.; Benedetti, F.; Tecchio, C.. - In: BONE MARROW TRANSPLANTATION. - ISSN 0268-3369. - 57:7(2022), pp. 1133-1141. [10.1038/s41409-022-01690-x]

Neurological complications in adult allogeneic hematopoietic stem cell transplant patients: Incidence, characteristics and long-term follow-up in a multicenter series

Candoni A.;
2022

Abstract

Neurological complications (NCs) represent a diagnostic and clinical challenge in allogeneic hematopoietic stem cell transplant (alloHSCT) patients. We retrospectively analyzed NC incidence, etiology, timing, characteristics, outcome, and long-term effects in 2384 adult patients transplanted in seven Italian institutions between January 2007 and December 2019. Ninety-three (3.9%) patients were affected by 96 NCs that were infectious (29.2%), immune/inflammatory (26%), drug-related (12.5%), cerebrovascular (5.2%), metabolic (3.1%), related to central nervous system disease relapse (11.5%) and malignancy (3.1%), or undefined (9.4%). Six patients (6.4%) had neurological manifestations of chronic graft-versus-host disease (GVHD). NCs occurred on average at day +128 (from −5 to +4063). Early (< day +120) and late NCs had similar frequencies (46.9% vs 53.1%, p = 0.39). Thirty-one patients (33.3%) were affected by acute or chronic GVHD at the NC onset. With a median follow-up of 25.4 (0.4–163) months, the overall mortality due to NCs was 22.6%. The median time between NC onset and death was 36 (1–269) days. Infectious NCs were the main cause (61.9%) of NC-related mortality. A persistent neurological impairment occurred in 20.4% patients, 57.9% of whom being affected by immune/inflammatory NCs. This study highlights the rare, yet severe impact of alloHSCT-associated NCs on patient survival and long-term functional ability.
2022
57
7
1133
1141
Neurological complications in adult allogeneic hematopoietic stem cell transplant patients: Incidence, characteristics and long-term follow-up in a multicenter series / Wieczorek, M.; Mariotto, S.; Ferrari, S.; Mosna, F.; Mico, M. C.; Borghero, C.; Dubbini, M. V.; Malagola, M.; Skert, C.; Andreini, A.; De Marco, B.; Polo, D.; Tfaily, A.; Krampera, M.; Grassi, A.; Candoni, A.; Ranzato, F.; Volonghi, I.; Quatrale, R.; Benedetti, F.; Tecchio, C.. - In: BONE MARROW TRANSPLANTATION. - ISSN 0268-3369. - 57:7(2022), pp. 1133-1141. [10.1038/s41409-022-01690-x]
Wieczorek, M.; Mariotto, S.; Ferrari, S.; Mosna, F.; Mico, M. C.; Borghero, C.; Dubbini, M. V.; Malagola, M.; Skert, C.; Andreini, A.; De Marco, B.; Polo, D.; Tfaily, A.; Krampera, M.; Grassi, A.; Candoni, A.; Ranzato, F.; Volonghi, I.; Quatrale, R.; Benedetti, F.; Tecchio, C.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1293940
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