Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Pediatrics), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Clin Transplant. 2019 Jan;33(1):e13459. doi: 10.1111/ctr.13459. Epub 2018 Dec 30.
Posterior reversible encephalopathy syndrome (PRES) is an increasingly recognized serious complication of cyclosporine A (CSA) and tacrolimus (TAC) use in hematopoietic cell transplantation (HCT) recipients.
A retrospective study was carried out, including 84 cases of HCT for TM from January 2012 to January 2017. Eleven cases were diagnosed with PRES.
The cumulative incidence of PRES was 13.4% (95% confidence interval (CI) 9.7%-17.2%). The median onset time of the symptoms was 63 [20, 143] days after transplantation. Lumber puncture found that CSF was normal. Univariate analysis showed that patients who received methylprednisolone (MP) (OR = 10.629 95% CI, 1.360-83.071, P = 0.024), female patients (OR = 4.275, 95% CI, 1.154-15.843, P = 0.032), patients who had severe hypertension (OR = 5.162, 95% CI, 1.042 to 25.559, P = 0.029) had significantly higher risks of PRES. Multivariate analysis showed that severe hypertension (hazard ratio [HR], 12.793; 95% CI, 1.477 to 110.813; P = 0.021), and Pesaro class 3 (HR, 3.367; 95% CI, 1.210 to 9.368; P = 0.020) were associated with PRES.
The severe hypertension is an independent risk factor for PRES post-HCT in children with thalassemia major. Patients of Pesaro class 3 may benefit from optimum control of blood pressure post-HCT for prophylaxis of PRES.
在后可逆性脑病综合征（PRES）是一种日益认识到严重的并发症环孢素 A（CSA）和他克莫司（TAC）在造血细胞移植（HCT）受者的使用。
进行了一项回顾性研究，包括 84 例从 2012 年 1 月至 2017 年 1 月间接受 HCT 的 TM 患者。11 例被诊断为 PRES。
PRES 的累积发生率为 13.4%（95%置信区间[CI]9.7%-17.2%）。症状的中位发病时间为移植后 63 [20, 143]天。腰椎穿刺发现脑脊液正常。单因素分析显示，接受甲基强的松龙（MP）（OR=10.629 95%CI, 1.360-83.071, P=0.024）、女性患者（OR=4.275, 95%CI, 1.154-15.843, P=0.032）、患有严重高血压的患者（OR=5.162, 95%CI, 1.042 至 25.559, P=0.029）发生 PRES 的风险明显更高。多因素分析显示，严重高血压（风险比[HR]，12.793；95%CI，1.477 至 110.813；P=0.021）和佩萨罗 3 级（HR，3.367；95%CI，1.210 至 9.368；P=0.020）与 PRES 相关。
严重高血压是儿童重型地中海贫血患者 HCT 后 PRES 的独立危险因素。佩萨罗 3 级患者可能受益于 HCT 后最佳血压控制以预防 PRES。
