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Neurological complications in Chinese children undergoing hematopoietic stem cell transplantation

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Abstract

Background

Hematopoietic stem cell transplantation, despite being a curative treatment for various pediatric disorders, is associated with significant acute and chronic complications.

Methods

This retrospective review of 196 hematopoietic stem cell transplantation episodes (144 allogeneic, 52 autologous) performed in a tertiary pediatric unit focused on neurological symptoms and complications occurred from the start of conditioning to within 3 years of transplantation. Indications for transplantation included both benign and malignant diseases. For episodes involving allogeneic transplantation, 42% of donors were matched-unrelated, 19% were matched-sibling, and 12% were haploidentical. 

Results

Neurological complications developed in 17% of all hematopoietic stem cell transplantation episodes. Tumors of central nervous system and leukemia or lymphoma were two indications reported to have higher incidence of 42% and 21%, respectively. The occurrence of neurological complications was significantly associated with primary diagnosis (p = 0.01), central nervous system involvement by underlying disease (p = 0.001), and radiation-based conditioning (p = 0.018). Upon multivariate analysis, central nervous system involvement by underlying disease remained to be the only significant factor (p = 0.019), while radiation-based containing conditioning (p = 0.029) is revealed to be associated when considering allogeneic transplantation alone. Pre-transplant central nervous system–directed treatment, allogeneic versus autologous donor, stem cell source, donor type, busulfan use, and cyclosporin use were not significantly associated with neurological complications. Patients with neurological complications were also found to have an inferior 2-year overall survival (53.9% ± 8.8% versus 63.8% ± 4.2%; p = 0.016).

Conclusion

Neurological complications were common in pediatric hematopoietic stem cell transplantation and were associated with adverse outcome; non-radiation containing conditioning regimens might be beneficial in mitigating the risk of such complications. 

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All data generated or analysed during this study are included in this published article.

Abbreviations

ATG:

Anti-thymocyte globulin

CMV:

Cytomegalovirus

CNS:

Central nervous system

CT:

Computed tomography

GvHD:

Graft-versus-host disease

HHV:

Human herpesvirus

HLA:

Human leukocyte antigen

HSCT:

Hematopoietic stem cell transplantation

MMF:

Mycophenolate mofetil

MRI:

Magnetic resonance imaging

MSD:

Matched-sibling donor

MUD:

Matched-unrelated donor

PBSC:

Peripheral blood stem cells

PNS:

Peripheral nervous system

PRES:

Posterior reversible encephalopathy syndrome

QMH:

Queen Mary Hospital

SIOPEN:

International Society of Paediatric Oncology Europe Neuroblastoma Group

TBI:

Total body irradiation

TLI:

Total lymphoid irradiation

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Acknowledgements

We would like to thank all doctors, nurses, and healthcare worker who contributed to the care of patients who underwent stem cell transplantation in Queen Mary Hospital, Hong Kong.

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Authors and Affiliations

  1. Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China

    Christy Yuen Kwan Mak, Daniel Ka Leung Cheuk, Pamela Pui Wah Lee, Alan Kwok Shing Chiang, Shau Yin Ha, Anthony Pak Yin Liu & Godfrey Chi Fung Chan

  2. Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong Special Administrative Region, China

    Christy Yuen Kwan Mak, Daniel Ka Leung Cheuk, Pamela Pui Wah Lee, Alan Kwok Shing Chiang, Shau Yin Ha, Anthony Pak Yin Liu & Godfrey Chi Fung Chan

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  1. Christy Yuen Kwan Mak
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Correspondence to Godfrey Chi Fung Chan.

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The study was approved by the Institutional Review Board of the University of Hong Kong with need for consent waived.

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Mak, C.Y.K., Cheuk, D.K.L., Lee, P.P.W. et al. Neurological complications in Chinese children undergoing hematopoietic stem cell transplantation. Childs Nerv Syst 37, 3753–3767 (2021). https://doi.org/10.1007/s00381-021-05235-3

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