Neurological Adverse Events Post Allogeneic Hematopoietic Cell Transplantation: Major Determinants of Morbidity and Mortality

Overview

Journal J Neurol

Specialty Neurology

Date 2019 May 16

PMID 31087160

Citations 8

Authors

Ioanna Sakellari

Eleni Gavriilaki

Sotirios Papagiannopoulos

Maria Gavriilaki

Ioannis Batsis

Despina Mallouri

Anna Vardi

Varnavas Constantinou

Marianna Masmanidou

Evangelia Yannaki

Christos Smias

Triantafyllos Geroukis

Dimitrios Kazis

Vasileios Kimiskidis

Achilles Anagnostopoulos

Affiliations

Soon will be listed here.

Abstract

Background: Despite advances in the field, diagnosis and management of the wide spectrum of neurological events post allogeneic hematopoietic cell transplantation (alloHCT) remain challenging. Therefore, we investigated their incidence, diagnosis, management and long-term prognosis in alloHCT recipients.

Methods: We retrospectively recorded data from consecutive alloHCT recipients with or without neurological complications in our center.

Results: Among 758 alloHCT recipients, 127 (16.8%) presented with neurological complications. Complications developed in central nervous system (89.7%) during the late post-transplant period. Neurological adverse events included a wide spectrum of infectious and non-infectious etiologies. With a median follow-up of 11.4 months, incidence of chronic graft-versus-host disease (GVHD) was 52.8%, relapse mortality 48.6%, transplant-related mortality 39.1% and 5-year overall survival (OS) 25.8% in patients with neurological complications. Timing of appearance of neurological complications, early or late, was associated only with acute and chronic graft-versus-host-disease/GVHD. Independent pre-transplant risk factors of neurological complications in the multivariate model were unrelated or alternative donors, ALL diagnosis and non-myeloablative conditioning. In multivariate analysis of post-alloHCT events, favorable OS was independently associated with resolution of neurological syndromes, absence of chronic GVHD and sibling transplantation. In our cohort, 10-year OS was significantly lower in patients with neurological complications and independently associated with acute and chronic GVHD, relapse, fungal and bacterial infections and neurological complications.

Conclusions: Our large study with long-term follow-up highlights the wide spectrum of neurological complications in alloHCT. Accurate recognition is required for adequate management, a major determinant of survival. Thus, long-term increased awareness and collaboration between expert physicians is warranted.

Citing Articles

Chronic Central Nervous System Graft-Versus-Host Disease to Unravel Progressive Visual Loss and Ischemic Stroke Recurrence Post-Allogeneic Hematopoietic Stem Cell Transplant: A Case Report.

Crescenzo F, Danese A, DallOra F, Turazzini M Int J Mol Sci. 2025; 26(5).

PMID: 40076907 PMC: 11900970. DOI: 10.3390/ijms26052289.

Hemostasis and complement in allogeneic hematopoietic stem cell transplantation: clinical significance of two interactive systems.

Tsakiris D, Gavriilaki E, Chanou I, Meyer S Bone Marrow Transplant. 2024; 59(10):1349-1359.

PMID: 39004655 PMC: 11452340. DOI: 10.1038/s41409-024-02362-8.

Molecular Advances in Sinusoidal Obstruction Syndrome/Veno-Occlusive Disease.

Mavrikou I, Chatzidimitriou D, Skoura L, Nikolousis E, Sakellari I, Gavriilaki E Int J Mol Sci. 2023; 24(6).

PMID: 36982695 PMC: 10051970. DOI: 10.3390/ijms24065620.

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, Borghero C Bone Marrow Transplant. 2022; 57(7):1133-1141.

PMID: 35513485 DOI: 10.1038/s41409-022-01690-x.

Acute Graft--Host Disease, Infections, Vascular Events and Drug Toxicities Affecting the Central Nervous System.

Vinnakota J, Zeiser R Front Immunol. 2021; 12:748019.

PMID: 34691059 PMC: 8527894. DOI: 10.3389/fimmu.2021.748019.

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