Cai Xuan, Fu Hai-Xia, Mo Xiao-Dong, Wang Yu, Zhang Yuan-Yuan, Wu Jin, Han Wei, Tang Fei-Fei, Gui Ruo-Yun, Chen Huan, Chen Yao, Zhao Peng, Yan Chen-Hua, Wang Jing-Zhi, Chen Yu-Hong, Chang Ying-Jun, Xu Lan-Ping, Liu Kai-Yan, Huang Xiao-Jun, Zhang Xiao-Hui
Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.
Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
Bone Marrow Transplant. 2020 Nov;55(11):2087-2097. doi: 10.1038/s41409-020-0903-8. Epub 2020 Apr 24.
Stroke is an important complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Nevertheless, few studies have been published to analyzed the occurrence and prognosis of stroke after allo-HSCT. From January 2007 to December 2018 in Peking University People's Hospital, 6449 patients received HSCT and there were 2.3% of patients diagnosed with stroke after allo-HSCT (hemorrhagic: 1.0%, ischemic: 1.3%). The median time to hemorrhagic and ischemic stroke after HSCT was 161 days and 137 days, respectively. In total, 8.4% of patients experienced neurological sequelae. The outcome was much worse in patients with stroke than in control subjects. The comparison of prognosis showed no statistical differences between patients with hemorrhagic stroke and those with ischemic stroke. Significant risk factors for hemorrhagic stroke were pretransplant central nervous system leukemia (CNSL), and delayed platelet engraftment. Risk factors associated with the occurrence of ischemic stroke included high-risk disease, prior venous thromboembolism (VTE), grade III-IV acute graft-versus-host disease (aGVHD), and thrombotic microangiopathy (TMA). Haplo-identical transplantation was not a risk factor for stroke and had no impact on the prognosis compared with HLA-matched HSCT. Altogether, these results show that stroke is a severe complication after allo-HSCT. The prognosis of posttransplant stroke did not differ between hemorrhagic and ischemic stroke.
中风是异基因造血干细胞移植（allo-HSCT）后的一种重要并发症。然而，针对allo-HSCT后中风的发生情况及预后的研究发表较少。2007年1月至2018年12月期间，北京大学人民医院共有6449例患者接受了HSCT，其中2.3%的患者在allo-HSCT后被诊断为中风（出血性中风：1.0%，缺血性中风：1.3%）。HSCT后发生出血性和缺血性中风的中位时间分别为161天和137天。总计8.4%的患者出现神经后遗症。中风患者的预后比对照组差得多。出血性中风患者和缺血性中风患者的预后比较无统计学差异。出血性中风的显著危险因素为移植前中枢神经系统白血病（CNSL）和血小板植入延迟。与缺血性中风发生相关的危险因素包括高危疾病、既往静脉血栓栓塞（VTE）、III-IV级急性移植物抗宿主病（aGVHD）和血栓性微血管病（TMA）。单倍体相合移植不是中风的危险因素，与HLA配型相合的HSCT相比，对预后也没有影响。总之，这些结果表明中风是allo-HSCT后的一种严重并发症。移植后出血性中风和缺血性中风的预后无差异。
