Severe hypertension is an independent risk factor for posterior reversible encephalopathy syndrome post‐hematopoietic cell transplantation in children with thalassemia major

• Published in: Clinical transplantation 2019-01, Vol.33 (1), p.e13459-n/a
• Main Authors: Li, Xin‐Yu, Huang, Ke, Zhou, Dun‐Hua, Li, Yang, Xu, Hong‐Gui, Weng, Wen‐Jun, Xu, Lu‐Hong, Fang, Jian‐Pei
• Format: Article
• Language: English
• Subjects: beta-Thalassemia - therapy; Child; Child, Preschool; Female; Follow-Up Studies; hematopoietic cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; hypertension; Hypertension - complications; Hypertension - physiopathology; Male; Posterior Leukoencephalopathy Syndrome - diagnosis; Posterior Leukoencephalopathy Syndrome - etiology; posterior reversible encephalopathy syndrome; Prognosis; Retrospective Studies; Risk Factors; thalassemia major
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.13459

Background 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. Procedure 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. Results 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. Conclusions 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.