Central Nervous System Complications After Allogeneic Hematopoietic Stem Cell Transplantation In Patients With Acute Leukemia:Risk Factors And Outcomes Analysis

PurposeAllogeneic hematopoietic stem cell transplantation(allo-HSCT)is an aggressive but effective treatment for acute leukemia(AL).Central nervous system complications(CNSCs)after transplantation varies in manifestation,causing difficulties in diagnosis and inferior in survival.We collected the data of patients with AL who received allo-HSCT at our center to analyze the risk factors and outcomes of CNSCs.MethodsWe retrospectively analyzed 602 patients with AL who underwent allo-HSCT at our center from January 2010 to December 2017.There were 332 males and 270 females The median age was 30(range 8-64)years old.There were 326 acute lymphoblastic leukemia and 276 acute myeloid leukemia patients,in which 381 were high-risk,221 weren’t high-risk.The typing,manifestation,morbidity and mortality were collected to analyze the risk factors and outcomes of CNSCs.ResultsA total of 77 patients(12.8%)developed CNSCs.The cumulative incidence of CNSCs at 30 days,100 days and 1 year post-transplantation was 1.7%,4.7%and 9.3%,respectively.The most common manifestation of CNSCs is alter of consciousness.The most common CNSCs were CNS tumor(33.8%)and cerebrovascular event(20.8%)Cerebrovascular event was the most common cause of death,accounting for 46.4%of mortality of CNSCs.Dependent risk factors for CNSCs were acute lymphoblastic leukemia(hazard ratio[HR]=2.06,p=0.004),no complete remission before transplantation(HR=2.78,p=0.006),BMI more than 24kg/m2(HR=1.73,p=0.028)and grade Ⅱ-Ⅳ acute GVHD(HR=1.22,p=0.048).CNSCs after allo-HSCT negatively impacted overall survival(HR=3.96,p<0.001)and non-relapse mortality(HR=4.21,p<0.001).ConclusionCNSCs are associated with poor outcomes of AL patients after allo-HSCT.Close attention should be given to individuals with risk factors for CNSCs.