Korean J Hematol.  2010 Sep;45(3):164-170. 10.5045/kjh.2010.45.3.164.

Early central nervous system complications after allogeneic hematopoietic stem cell transplantation in children

• Koh KN
• Park M
• Kim BE
• Im HJ
• Seo JJ

• KMID: 2252057
• DOI: http://doi.org/10.5045/kjh.2010.45.3.164

Abstract

BACKGROUND
Central nervous system (CNS) complications after allogeneic hematopoietic stem cell transplantation (HSCT) have not been well characterized in the pediatric population.
METHODS
We retrospectively analyzed data of 202 consecutive children who underwent allogeneic HSCT (60 from matched related donors, 9 from mismatched related donors, and 133 from unrelated donors) at Asan Medical Center between 1998 and 2009.
RESULTS
Twenty-seven children (13.5%) developed CNS complications within 6 months after HSCT. Calcineurin inhibitor (CNI)-associated neurotoxicity was the most common CNS complication (n=16), followed by CNS infection (n=2), cerebrovascular events (n=2), thrombotic microangiopathy-associated events (n=2), metabolic encephalopathy (n=2), irradiation/chemotherapy injury (n=1), and encephalopathy/myelopathy of unknown causes (n=2). Univariate analysis showed that a transplant from an alternative donor and the occurrence of acute graft-versus-host disease (GVHD) (>grade 2) were associated with a significantly increased risk of CNS complications. In the multivariate analysis, acute GVHD >grade 2 was identified as an independent risk factor for early CNS complications. The 5-year overall survival rate was significantly lower in patients with CNS complications (52.1% vs. 64.9%, P=0.014), whereas CNI-associated neurotoxicity did not affect the survival outcome.
CONCLUSION
CNS complications are frequent among children undergoing HSCT, contributing to early death after transplant. More attention should be paid to the development of CNS complications for recipients of alternative donor transplants and patients with severe acute GVHD who are at increased risk for CNS complications.

Keyword

Allogeneic; Hematopoietic stem cell transplantation; Neurological complication; Cyclosporine; Children

MeSH Terms

Brain Diseases, Metabolic
Calcineurin
Central Nervous System
Child
Cyclosporine
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Humans
Multivariate Analysis
Retrospective Studies
Risk Factors
Survival Rate
Tissue Donors
Transplants
Calcineurin
Cyclosporine

Figure

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  Fig. 1 The cumulative incidence of central nervous system complications according to different types of donor within 6 months posttransplant. CI, confidence interval; HSCT, hematopoietic stem cell transplantation.

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  Fig. 2 Kaplan-Meier plots of overall survival in patients with and without CNS complications (A) and CNI neurotoxicity (B) within 6 months posttransplant. CNS, central nervous system; CNI, calcineurin inhibitor; HSCT: hematopoietic stem cell transplantation.

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