title: Early central nervous complications after umbilical cord blood transplantation for adults.
abstract: Early central nervous complications (CNS) are significant after allogeneic stem cell transplantation; however, the clinical characteristics of early CNS complications have not yet been well described. The medical record of 77 patients who underwent cord blood transplantation (CBT) between March 2001 and November 2005, at 8 centers of the Nagoya Blood and Marrow Transplantation Group were retrospectively reviewed. The preparative regimen included myeloablative CBT (n = 31) or reduced-intensity (RI)-CBT (n = 46). Of the 77 patients, 10 (13%) developed early CNS complications. Causes included Cyclosporine encephalopathy (n = 5), tacrolimus encephalopathy (n = 2), thrombocytic microangiopathy (n = 1), and unknown (n = 3). The median time of onset was 19 days (range: 2-58 days). All of the 10 patients developed impaired consciousness. Seizures developed in 6 patients. Early CNS complications spontaneously subsided in 3 patients. Three patients responded to cyclosporine or tacrolimus discontinuation. The remaining 4 patients died within 30 days of developing of early CNS complications. No relationship was detected between the preparative regimen and the onset of early CNS complications, while an HLA disparity showed borderline significance (hazard ratio, 3.24; 95% confidential interval, 0.94-11.20; P = .06). Early CNS complications are a significant problem after CBT, and the clinician has to be aware of the possibility of these complications.
authors.affiliation: Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan. hiroto-narimatsu@umin.net
authors.forename: Hiroto
authors.initials: H
authors.lastname: Narimatsu
authors.forename: Koichi
authors.initials: K
authors.lastname: Miyamura
authors.forename: Hiroatsu
authors.initials: H
authors.lastname: Iida
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hamaguchi
authors.forename: Toshiki
authors.initials: T
authors.lastname: Uchida
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Morishita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002493:Central Nervous System Diseases / Q000209:etiology; D003244:Consciousness Disorders / Q000209:etiology; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D006648:Histocompatibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D016559:Tacrolimus / Q000009:adverse effects; D013927:Thrombosis; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D016572:Cyclosporine; D016559:Tacrolimus