Risk factors and survival analysis for central nervous system complications after allogeneic hematopoietic stem cell transplantation.

Abstract

To investigate the risk factors as well as their impact on patients' survival of central nervous system (CNS) complications following allogeneic hematopoietic stem cell transplantation (HSCT). All relevant clinical data from a total of 323 patients, who underwent allogeneic HSCT in Xiangya Hospital of Central South University from September 2016 to September 2019, were retrospectively reviewed in this study. The complications' occurrence time, common symptoms and some other clinical data of the patients who developed CNS complications were analyzed descriptively. The risk factors for CNS complications following allogeneic HSCT were analyzed through univariate and multivariate analysis. And the survival analysis was conducted as well. Among the 323 patients who underwent allogeneic HSCT, 32 patients developed CNS complications. These complications occurred in these patients at a median of 32 (range from -1 to 584) d after transplantation. Common symptoms were disturbance of consciousness (78.1%), convulsion (59.4%), and headache (12.5%). Univariate analysis showed that there were significant differences in neutrophil engraftment, platelet (PLT) engraftment, serum cytomegalovirus (CMV) DNA positive, combined with acute graft-versus-host disease (aGVHD), donor selection (P=0.011, P<0.001, P=0.006, P<0.001 or P=0.035, respectively). Multivariate analysis showed that the delay or the failure of PLT engraftment (P<0.001) and combined with aGVHD (P<0.001) were the risk factors for CNS complications. Survival analysis showed that the 1-year overall survival rate (OS) and 2-year OS were significantly lower in patients who developed CNS complications than in the non-CNS complication group (55%±9% vs 89%±2%, 37%±11% vs 85%±3%; both P<0.001). The 1-year disease-free survival rate (DFS) and 2-year DFS were significantly lower in patients who developed CNS complications than in the non-CNS complication group (55%±9% vs 88%±2%, 29%±11% vs 83%±3%; both P<0.001). The 1-year transplantation-related mortality (TRM) and 2-year TRM were significantly higher in patients who developed CNS complications than those in the non-CNS complication group (45%±9% vs 8%±2%, 58%±11% vs 11%±2%; both P<0.001). The delay or the failure of PLT engraftment and combined with aGVHD are the risk factors for CNS complications. The facts indicate that we should prevent CNS complications when patients who underwent allogeneic HSCT with the delay or the failure of PLT engraftment or aGVHD. Compared with non-CNS complication group, patients who developed CNS complications usually have poor prognosis.