Kang Ji-Man, Kim Yae-Jean, Kim Ju Youn, Cho Eun Joo, Lee Jee Hun, Lee Mun Hyang, Lee Soo-Hyun, Sung Ki Woong, Koo Hong Hoe, Yoo Keon Hee
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Biol Blood Marrow Transplant. 2015 Jun;21(6):1091-8. doi: 10.1016/j.bbmt.2015.02.007. Epub 2015 Feb 21.
Neurologic complications are serious complications after hematopoietic stem cell transplantation (HSCT) and significantly contribute to morbidity and mortality. The purpose of this study was to investigate the clinical features and prognosis in pediatric patients who had neurologic complications after allogeneic HSCT. We retrospectively reviewed the medical records of children and adolescents (19 years old or younger) who underwent allogeneic HSCT at our institution from 2000 to 2012. A total of 383 patients underwent 430 allogeneic transplantations. Among them, 73 episodes of neurologic complications occurred in 70 patients. The cumulative incidence of neurologic complications at day 400 was 20.0%. Almost two thirds of the episodes (63.0%, 46 of 73) occurred within 100 days after transplantation. Calcineurin inhibitor-related neurotoxicity was observed as the most common cause of neurotoxicity (47.9%, 35 of 73) and was significantly associated with earlier onset neurologic complications, seizure, and tremor. It also showed a significant association with lower probability of headache, abnormality of cranial nerve, and neurologic sequelae. In a multivariate analysis, days to neutrophil engraftment after HSCT, extensive chronic graft-versus-host disease (GVHD) and the existence of neurologic sequelae were identified as risk factors for mortality in patients who had neurologic complications (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.02 to 1.15; P = .011; HR, 5.98; 95% CI, 1.71 to 20.90; P = .005; and HR, 4.37; 95% CI, 1.12 to 17.05; P = .034, respectively). However, there was no significant difference in the 5-year overall survival between the patients who had neurologic complications without sequelae and the patients who did not have any neurologic complications (57.3% versus 61.8%, P = .906). In conclusion, we found that the major significant risk factors for mortality in pediatric recipients with neurologic complications were the existence of neurologic sequelae and extensive chronic GVHD.
神经并发症是造血干细胞移植（HSCT）后的严重并发症，对发病率和死亡率有显著影响。本研究的目的是调查异基因HSCT后发生神经并发症的儿科患者的临床特征和预后。我们回顾性分析了2000年至2012年在我院接受异基因HSCT的儿童和青少年（19岁及以下）的病历。共有383例患者接受了430次异基因移植。其中，70例患者发生了73次神经并发症。400天时神经并发症的累积发生率为20.0%。几乎三分之二的发作（63.0%，73例中的46例）发生在移植后100天内。观察到钙调神经磷酸酶抑制剂相关神经毒性是神经毒性最常见的原因（47.9%，73例中的35例），并且与较早发生的神经并发症、癫痫和震颤显著相关。它还与头痛、颅神经异常和神经后遗症的较低发生率显著相关。在多变量分析中，HSCT后中性粒细胞植入天数、广泛慢性移植物抗宿主病（GVHD）和神经后遗症的存在被确定为有神经并发症患者死亡的危险因素（风险比[HR]，1.08；95%置信区间[CI]，1.02至1.15；P = .011；HR，5.98；95%CI，1.71至20.90；P = .005；以及HR，4.37；95%CI，1.12至17.05；P = .034）。然而，没有神经后遗症的神经并发症患者与没有任何神经并发症的患者之间的5年总生存率没有显著差异（57.3%对61.8%，P = .906）。总之，我们发现有神经并发症的儿科受者死亡的主要显著危险因素是神经后遗症的存在和广泛慢性GVHD。
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