Neurological complications in Chinese children undergoing hematopoietic stem cell transplantation

Mak, Christy Yuen Kwan; Cheuk, Dkl; Lee, Pamela; Chiang, Alan Kwok Shing; Ha, Shau Yin; Liu, Anthony Pak Yin; Chan, Godfrey Chi Fung

doi:10.1007/s00381-021-05235-3

Cited by 2 publications

(7 citation statements)

References 28 publications

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“…The incidence of abnormal findings in autopsies is up to 90% (24). A recent Chinese study assessing 196 children (8) found the incidence to be 17%, comparable with our results (and similar to the 14.8% incidence in a recent study on 888 adult allotransplanted patients) (17). The incidence of NCs after HSCT is higher than in children treated with chemotherapy only (10).…”

Section: Neurological Complications 107supporting

confidence: 91%

“…Noninfectious NCs were more than four times frequent than infectious NCs in our cohort. The reported incidence of CNS infections after allogeneic HSCT ranges from 7.5% to 27%, a smaller part from the overall incidence of NCs as described previously (1,3,7,8,10,14); our findings are within that range.…”

Section: Neurological Complications 107supporting

confidence: 78%

“…NCs can occur secondary to a range of infectious and noninfectious causes, including medicationinduced, metabolic, vascular, immune-mediated, or diseaserelated neurotoxicity (including relapse) (5,13). Prevalence of infectious NCs is less than that of noninfectious NCs (1,3,7,8,10,14). Many factors affect the incidence and severity of NC after HSCT including allogeneic transplantation (1,4,5,9,11), mismatched donor (3,4,9,12), radiation-based conditioning regimen (1,8), and GVHD (3-5, 9, 12).…”

Section: Introductionmentioning

confidence: 99%

“…Prevalence of infectious NCs is less than that of noninfectious NCs (1,3,7,8,10,14). Many factors affect the incidence and severity of NC after HSCT including allogeneic transplantation (1,4,5,9,11), mismatched donor (3,4,9,12), radiation-based conditioning regimen (1,8), and GVHD (3-5, 9, 12).…”

Section: Introductionmentioning

confidence: 99%

“…The survival rates of patients who develop NCs, both children and adults, are reduced (8,9,12,17); mortality could be attributed to the NCs in more than half of the cases (8,11); and 27%-43% (5,7,18) suffer from long-term neurological sequelae. NCs are often accompanied by neuroimaging changes such as brain edema, intracranial hemorrhage, ring-enhancing lesions or abscess, and cortical dysplasia (19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

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Neurological complications following pediatric allogeneic hematopoietic stem cell transplantation: Risk factors and outcome

et al. 2022

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BackgroundAllogeneic hematopoietic stem cell transplantation (HSCT) is an efficient treatment for numerous malignant and nonmalignant conditions affecting children. This procedure can result in infectious and noninfectious neurological complications (NCs).ObjectiveThe objective of the study is to examine the incidence, risk factors, and outcomes of NCs in pediatric patients following allogeneic HSCT.MethodsWe performed a retrospective study of 746 children who underwent 943 allogeneic HSCTs in two large pediatric hospitals in Israel from January 2000 to December 2019.ResultsOf the pediatric patients 107 (14.3%) experienced 150 NCs. The median follow-up was 55 months. Noninfectious NCs were more common than infectious NCs (81.3% vs. 18.7%). Factors significantly associated with type of NC (infectious vs. noninfectious) were underlying disease (immunodeficiency vs. malignant and metabolic/hematologic disease) (p-value = 0.000), and use of immunosuppressive agent, either Campath or ATG (p-value = 0.041). Factors with a significant impact on developing neurological sequelae post-NC were number of HSCT >1 (p-value = 0.028), the use of alemtuzumab as an immunosuppressive agent (p-value = 0.003), and infectious type of NC (p-value = 0.046). The overall survival rate of whole NC-cohort was 44%; one-third of all mortality cases were attributed to the NC. The strongest prognostic factors associated with mortality were older age at HSCT (p-value = 0.000), the use of alemtuzumab as an immunosuppressive agent (p-value = 0.004), and the existence of neurological sequelae (p-value = 0.000). Abnormal central nervous system imaging (p-value = 0.013), the use of alemtuzumab as an immunosuppressive agent (p-value = 0.019), and neurological sequelae (p-value = 0.000) had statistically significant effects on neurological cause of death.ConclusionInfectious and noninfectious NCs are a significant cause of morbidity and mortality following allogeneic HSCT in children. Further research is required to better understand the risk factors for different NCs and their outcomes regarding sequelae and survival.

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Section: Neurological Complications 107supporting

confidence: 91%