196 Outcomes of Patients with Central Nervous System Complications After Allogeneic Hematopoietic Stem Cell Transplantation

Track: Contributed Abstracts
Wednesday, February 13, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Mojtaba Akhtari, MD , Internal medicine, University of Nebraska Medical Center, Omaha, NE
Jagar Jasem, MD , College of Public Health, University of Nebraska Medical Center
James O Armitage, MD , Internal Medicine, University of Nebraska Medical Center, Omaha, NE
Vamshi KS Balasetti, MBBS , Internal medicine, University of Nebraska Medical Center
Philip J. Bierman, MD , Department of Internal Medicine, BMT, University of Nebraska Medical Center, Omaha, NE
Edward A Faber, DO , University of Nebraska Medical Center
Pierre Fayad, MD , Department of Neurological Sciences, University of Nebraska Medical Center (UNMC)
Abdul Hadi, MS , University of Nebraska Medical Center, Omaha, NE
Fausto Rodriguez Loberiza, MD, MS , Univ of Nebraska Med Ctr, Omaha, NE
Lori Maness, MD , Oncology/Hematology, University of Nebraska Medical Center, Omaha, NE
Armando DA Rosales , College of Public Health, University of Nebraska Medical Center
Julie M Vose, MD , Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
Robert G Bociek, MD, MS , Oncology/Hematology, University of Nebraska Medical Center, Omaha, NE

Outcomes of Central Nervous System Complications after Allogeneic Hematopoietic Stem Cell Transplantation: A Single Center Experience

Background. Allogeneic hematopoietic stem cell transplantation (AHSCT) is a common treatment modality for patients (pts) with hematological disorders. We present a retrospective review of the incidence and impact on outcomes of central nervous system complications (CNSCs) in a cohort of pts with hematological disorders undergoing AHSCT, treated at a single institution.

Methods. 351 pts with hematological disorders who received AHSCT between 2002 and 2011 at an academic medical center were identified. Events that were considered CNSCs included seizures, transient ischemic attack, intracranial hemorrhage, ischemic stroke, subarachnoid hemorrhage, subdural hematoma, meningitis, and posterior reversible encephalopathy syndrome (PRES). Data were obtained from a review of the databases and medical records.

Patient-, disease- and transplant-related characteristics were compared between pts with or without CNSCs. Cumulative incidence of having CNSCs were estimated using death as competing risk. Multivariate Cox proportional hazard regression analysis was used to compare the risk of mortality between pts with or without CNSCs while adjusting for prognostic factors. Prognostic factors considered included: age, sex, disease type, disease stage at transplant, donor-recipient sex-match, cmv status, type of transplant, level of antigen matching, graft type, year of transplant, use of total body irradiation, and prior exposure to cytarabine or cranial irradiation.   

Results. Of the 351 pts identified, forty-five pts developed CNSCs (12.8%). No differences in patient-, disease- and transplant-related characterisitcs were noted between those with or without CNSCs. The 100-day cumulative incidence of CNSCs was 8% (95% confidence interval [CI] 8-15%). The most commonly observed CNSCs included: PRES 18 (40%), stroke or TIA 11 (24%), seizures 9 (20%), and infection 4 (9%).  In univariate analysis, there was a difference in overall survival (OS) according to CNSCs (log-rank p= 0.0002). The OS at 5 years for pts with CNSCs was 14% (3-32) vs. 44% for pts without CNSCs (p-value 0.0004). In multivariate analysis, the risk of mortality for pts with CNSCs after AHSCT was significantly higher, hazard ratio (HR) 1.56 (95% CI 1.03 – 2.36, p= 0.04) compared to pts without CNSCs. Other prognostic factors identified included: sex, disease type, disease stage at transplant, level of antigen matching. Interestingly, prior history of high dose cytarabine was also associated with higher mortality, HR 2.19 (95% CI 1.51 – 3.18), p <0.0001.

Conclusion. The incidence of CNSCs after AHSCT is associated with reduced survival. Identifying pts at risk, monitoring, early identification, and treatment for CNSCs post AHSCT is needed to help alter the negative impact on outcomes.

 

See more of: Poster Session 1: Late Effects/Quality of Life/Psychosocial Issues
See more of: Contributed Abstracts
<< Previous Abstract | Next Abstract >>