دورية أكاديمية
Neurologic Complications of the Central Nervous System after Allogeneic Stem Cell Transplantation: The Role of Transplantation-Associated Thrombotic Microangiopathy as a Potential Underreported Cause.
| العنوان: | Neurologic Complications of the Central Nervous System after Allogeneic Stem Cell Transplantation: The Role of Transplantation-Associated Thrombotic Microangiopathy as a Potential Underreported Cause. |
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| المؤلفون: | Sala E; Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany. Electronic address: elisa.sala@uniklinik-ulm.de., Neagoie AM; Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany., Lewerenz J; Department of Neurology, University Hospital Ulm, Ulm, Germany., Saadati M; Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany., Benner A; Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany., Gantner A; Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany., Wais V; Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany., Döhner H; Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany., Bunjes D; Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany. |
| المصدر: | Transplantation and cellular therapy [Transplant Cell Ther] 2024 Jun; Vol. 30 (6), pp. 586.e1-586.e11. Date of Electronic Publication: 2024 Mar 19. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101774629 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2666-6367 (Electronic) Linking ISSN: 26666367 NLM ISO Abbreviation: Transplant Cell Ther Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [New York] : Elsevier Inc., [2021]- |
| مواضيع طبية MeSH: | Thrombotic Microangiopathies*/etiology , Thrombotic Microangiopathies*/epidemiology , Hematopoietic Stem Cell Transplantation*/adverse effects , Graft vs Host Disease*/etiology , Graft vs Host Disease*/epidemiology, Humans ; Male ; Female ; Middle Aged ; Adult ; Retrospective Studies ; Risk Factors ; Transplantation, Homologous/adverse effects ; Calcineurin Inhibitors/adverse effects ; Calcineurin Inhibitors/therapeutic use ; Incidence ; Tacrolimus/adverse effects ; Tacrolimus/therapeutic use ; Central Nervous System Diseases/etiology ; Central Nervous System Diseases/epidemiology ; Young Adult ; Adolescent ; Aged ; Cyclosporine/adverse effects ; Cyclosporine/therapeutic use ; Immunosuppressive Agents/adverse effects ; Immunosuppressive Agents/therapeutic use |
| مستخلص: | Neurologic complications (NCs), especially those of the central nervous system (CNS), represent a severe complication after allogeneic stem cell transplantation (allo-HSCT) and are associated with relevant morbidity and mortality. We aimed to characterize the potential risk factors for the development of CNS-NC, with a special focus on the role of calcineurin inhibitors (CNIs) as a predisposing factor. For this purpose, we compared cyclosporin A (CsA) versus tacrolimus (TAC) with respect to their influence on the incidence and type of CNS-NC after allo-HSCT. We retrospectively analyzed the incidence, risk factors, and impact on outcomes of CNS-NC diagnosed during the post-transplantation follow-up in patients with different high-risk hematologic malignancies who underwent allo-HSCT at our institution over a 20-year period. All patients included in the analysis received CNI (CsA or TAC) as graft-versus-host disease (GVHD) prophylaxis. We evaluated a total of 739 consecutive patients who underwent transplantation between December 1999 and April 2019. During a median follow-up of 6.8 years, we observed a CNS-NC incidence of 17%. The development of CNS-NC was associated with decreased overall survival (OS) and increased transplantation-related mortality (TRM). The most frequent CNS-NCs were infections (30%) and neurologic adverse events related to the administration of CNI, TAC, or CsA as GVHD prophylaxis (42%). In the multivariable analysis, age, total body irradiation (TBI), and severe acute GVHD and chronic GVHD were significant risk factors in the development of CNS-NCs. TAC compared with CsA emerged as an independent predisposing factor for CNS-NCs. The TAC-associated risk of CNS-NCs was related mostly to the occurrence of transplantation-associated thrombotic microangiopathy (TA-TMA) with neurologic manifestations (neuro-TA-TMA), although the general TA-TMA incidence was comparable in the 2 CNI subgroups. CNS-NCs are associated with poor prognosis after allo-HSCT, with TAC emerging as a potential yet insufficiently characterized predisposing factor. (Copyright © 2024 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Allogeneic stem cell transplantation; Neurologic complications; Tacrolimus; Transplantation-associated thrombotic microangiopathy |
| المشرفين على المادة: | 0 (Calcineurin Inhibitors) WM0HAQ4WNM (Tacrolimus) 83HN0GTJ6D (Cyclosporine) 0 (Immunosuppressive Agents) |
| تواريخ الأحداث: | Date Created: 20240320 Date Completed: 20240530 Latest Revision: 20240530 |
| رمز التحديث: | 20240531 |
| DOI: | 10.1016/j.jtct.2024.03.017 |
| PMID: | 38508452 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 2666-6367 |
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| DOI: | 10.1016/j.jtct.2024.03.017 |