Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.
Clin Transplant. 2013 Jan-Feb;27(1):80-9. doi: 10.1111/ctr.12000. Epub 2012 Sep 2.
The incidence of epileptic seizures among allogeneic hematopoietic stem cell transplant (allo-HSCT) patients has been poorly described. No report has systematically studied epilepsy's possible causes, risk factors, and effect on prognosis among allo-HSCT patients. We retrospectively examined data from 1461 patients who underwent allo-HSCT within the past 6.5 yr at the Institute of Hematology and People's Hospital, Peking University. The cumulative incidence of all epileptic seizure complications was 7.1%. Of the 79 transplant patients who had epileptic seizures, 3 (3.8%) experienced a seizure during the conditioning stage, 52 (65.8%) between day 0 and day 100, 20 (25.3%) from day 100 to the first year, and 4 (5.1%) after the first year. Multivariate regression analysis identified the age of the recipient as (≤ 18 yr) (p < 0.001), donor type (p = 0.004), graft versus host disease (aGVHD) (p = 0.018), and hyponatremia (p = 0.003) as independent risk factors for epileptic seizures among allo-HSCT patients. The median survival time of patients with epileptic seizures was 246 d after transplantation (ranging between 18 and 2170 d). Survival after one yr and 6.5 yr was significantly reduced in patients who developed epileptic seizure complications compared with those who did not (57.2% vs. 75.7% at one yr, p = 0.015, and 31.1% vs. 71.4% at five yr, p < 0.001). Of the 79 patients who experienced epileptic seizure complications, 53.2% died (n = 42). The survival rate of these patients was relatively low, and cerebrovascular disorders or central nervous system infection-related epileptic seizures usually resulted in a high mortality and poor prognosis. A patient transplantation age which is younger than 18 yr, related mismatched transplants, aGVHD, and hyponatremia are risk factors for epileptic seizures in allo-HSCT recipients. Epileptic seizures among allo-HSCT patients are associated with a poor prognosis.
异基因造血干细胞移植（allo-HSCT）患者癫痫发作的发生率描述甚少。目前尚无研究系统性地探讨 allo-HSCT 患者癫痫的可能病因、危险因素及其对预后的影响。我们回顾性分析了过去 6.5 年内在北京大学人民医院血液病研究所接受 allo-HSCT 的 1461 例患者的数据。所有癫痫发作并发症的累积发生率为 7.1%。在 79 例癫痫发作的移植患者中，有 3 例（3.8%）在预处理阶段发作，52 例（65.8%）在 0 至 100 天之间发作，20 例（25.3%）在 100 天至 1 年内发作，4 例（5.1%）在 1 年后发作。多变量回归分析确定了受体年龄（≤18 岁）（p<0.001）、供者类型（p=0.004）、移植物抗宿主病（GVHD）（p=0.018）和低钠血症（p=0.003）是 allo-HSCT 患者癫痫发作的独立危险因素。癫痫发作患者的中位生存时间为移植后 246 d（范围为 18 至 2170 d）。与未发生癫痫发作并发症的患者相比，发生癫痫发作并发症的患者 1 年和 6.5 年的生存率显著降低（1 年时分别为 57.2%和 75.7%，p=0.015，5 年时分别为 31.1%和 71.4%，p<0.001）。在发生癫痫发作并发症的 79 例患者中，53.2%（n=42）死亡。这些患者的生存率相对较低，脑血管疾病或中枢神经系统感染相关的癫痫发作通常导致高死亡率和预后不良。小于 18 岁的患者移植年龄、相关不匹配的移植、GVHD 和低钠血症是 allo-HSCT 受者癫痫发作的危险因素。allo-HSCT 患者的癫痫发作与不良预后相关。
