title: Central Nervous System Complications and Outcomes After Allogeneic Hematopoietic Stem Cell Transplantation.
abstract: BACKGROUND
  Central nervous system complications (CNSC) can be the cause of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). We aimed to determine the incidence of CNSC and its impact on survival.
  
  
  METHODS
  This retrospective cohort study included patients with hematologic disorders who received allo-HSCT between 2002 and 2011 at the University of Nebraska Medical Center.
  
  
  RESULTS
  Of the 351 patients identified, 45 developed CNSC (12.8%). The 100-day cumulative incidence of CNSC was 8% (95% confidence interval, 8-15). The most common CNSC included posterior reversible encephalopathy syndrome (40%), stroke or transient ischemic attack (24%), seizures (20%), and infection (9%). The 5-year overall survival was significantly lower among patients with versus without CNSC (14% vs. 44%, P = .0004). In multivariate analysis, the risk of mortality for patients with versus without CNSC was significantly higher (hazard ratio, 1.56; 95% confidence interval, 1.03-2.36; P = .04).
  
  
  CONCLUSIONS
  The occurrence of CNSC after allo-HSCT was associated with reduced survival. Identifying patients at risk, monitoring, early detection, and management of CNSC after allo-HSCT are needed to improve outcomes.
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Vijaya Raj
authors.initials: VR
authors.lastname: Bhatt
authors.affiliation: Department of Neurology, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Vamshi
authors.initials: V
authors.lastname: Balasetti
authors.affiliation: Department of Neurology, Ohio State University, Columbus, OH.
authors.forename: Jagar A
authors.initials: JA
authors.lastname: Jasem
authors.affiliation: Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Smith
authors.initials: S
authors.lastname: Giri
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE.
authors.forename: James O
authors.initials: JO
authors.lastname: Armitage
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Fausto R
authors.initials: FR
authors.lastname: Loberiza
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE.
authors.forename: R Gregory
authors.initials: RG
authors.lastname: Bociek
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Bierman
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Maness
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Vose
authors.affiliation: Department of Neurology, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fayad
authors.affiliation: Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE. Electronic address: mojtaba.akhtari@unmc.edu.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Akhtari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054038:Posterior Leukoencephalopathy Syndrome / Q000209:etiology* / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology* / Q000401:mortality; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Allogeneic hematopoietic stem cell transplantation; Central nervous system complications; Posterior reversible encephalopathy syndrome; Seizure; Stroke; Survival