PF778 ANALYSIS OF CENTRAL NERVOUS SYSTEM COMPLICATIONS AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION

• Published in: HemaSphere 2019-06, Vol.3 (S1), p.343-n/a
• Main Authors: Vilas, C. Insua, Núñez, R.M. Rodríguez, Cereijo, P.M. García, Muñiz, Ó. Domínguez, López, C. Albo, Fernández, M.D. L.Á. Fernández
• Format: Article
• Language: English
• ISSN: 2572-9241; 2572-9241
• DOI: 10.1097/01.HS9.0000561396.22749.91

Background: Central nervous system complications (CNSC) are a significant cause of hematopoietic stem cell transplantation (HSCT) related morbimortality, whose kind and frequency depends upon type of HSCT, baseline disease (BD), drugs and myelosupression. We identified several risk periods: discussing allogenic HSCT (alloHSCT) we distinguish conditioning and infusion (CI), first 30 days after HSCT (30HSCT), 30–100 days after (30–100HSCT) and >100 days after (>100HSCT); in autologous HSCT (autoHSCT), we identified 6mHSCT). Prompt and accurate diagnosis is a complex challenge, because symtoms are often atypical/nonspecific or even masked by metabolic/systemic disorders and immunosuppression (IS). Aims: We conducted a descriptive study including CNSC among HSCT in a tertiary hospital, analyzing BD, type of HSCT and complications, risk factors and mortality among others; moreover, we aim to compare ours and other published series. Methods: Retrospective case series. Data from HSCT performed in our hospital since January/2012 up to December/2018 was collected. A descriptive analysis was conducted; qualitative variables are presented as absolute frequencies and percentages; and quantitative ones as median and standard deviation. Chi2 and Exact Fisher test were performed when comparing qualitative variables. Data was analized by SPSS Statistics. Results: 40 patients developed CNSC: 67.5% male and 32.5% female, median age 57 y/o. Most prevalent BD were leukemia (35%), lymphoma (25%) and myeloma (25%). Most common CNSC were drug‐related (DC; 35,5 %, n = 16), infections (IC; 22,2%, n = 10) and BD progression (PC; 13,5%, n = 6). We had 3 metabolic CNSC (MC), 3 thrombotic (TC), 3 due to other causes (OC), 2 hemorrhages (HC) and 1 immune (GVHD). 27,5% (n = 11) were autoHSCT, prevailing DC (33,3%) and PC (25%); 72,5% were alloHSCT (n = 29), outlining DC(37,5%), IC (31,2%) and less often PC (9,3%). It's important to note that IC happened only amisdt alloHSCT, 70% of whom were neutropenic and 50% had low CD4 counts and hypogammaglobulinaemia. Among HC, 100% had severe thrombocytopenia. Lastly, 75% of DC happened in alloHSCT, thrombotic microangiopathy (TMA) being the main cause, particularly by calcineurin inhibitors (50%). Most frequent CNSC in alloHSCT happened >100HSCT (56.2%) and 30HSCT (25%), as compared to 12.5% over 30–100HSCT and 6.2% over CI. DC prevailed over CI; DC and IC were the most common over 30HSCT; no