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Cerebrovascular disease after allogeneic hematopoietic stem cell transplantation: incidence, risk, and clinical outcome

  • Ting-An Lin
  • Jyh-Pyng Gau
  • Yao-Chung LiuEmail author
  • Po-Shen Ko
  • Hao-Yuan Wang
  • Sheng-Hsuan Chien
  • Chia-Jen Liu
  • Liang-Tsai Hsiao
  • Tzeon-Jye Chiou
  • Jin-Hwang Liu
Original Article
  • 26 Downloads

Abstract

Cerebrovascular complications after hematopoietic stem cell transplantation (HSCT) cause serious morbidity and often contribute to mortality. The incidence, risk factors, and outcome of cerebrovascular disease (CVD) after allogeneic HSCT remain poorly defined. We retrospectively evaluated 459 adult patients who underwent allogeneic HSCT at a tertiary medical center between January 2003 and December 2015. A total of 20 patients (4.4%) developed post-transplant CVD. All cerebrovascular accidents occurred in the first two years post-transplant. The two-year incidences of post-transplant CVD, intracranial hemorrhage, and cerebrovascular infarction were 6.1%, 3.2%, and 3.2%, respectively. The incidence rate of CVD within two years after HSCT was 34.7 (95% CI 22.3 to − 53.7) per 1000 person-years, which was about tenfold higher than the general Taiwanese population. The only significant risk factor associated with post-transplant CVD is prior exposure to three or more courses of high-dose cytarabine. Post-transplant CVD is associated with dismal outcome and early mortality. The median overall survival of patients with post-transplant CVD was markedly reduced compared with those without CVD (8.0 vs. 60.6 months). Most patients with post-transplant CVD died within two months after the CVD events. Our study demonstrates that CVD remains a devastating complication after allogeneic HSCT in the modern era.

Keywords

Cerebrovascular disease Allogeneic hematopoietic stem cell transplantation Intracranial hemorrhage Cerebrovascular infarction High-dose cytarabine 

Notes

Author contributions

TAL performed the statistical analysis and wrote the paper. YCL coordinated and designed the study, interpreted data and critically revised the manuscript. The other authors participated in acquisition and analysis of clinical and laboratory data. All authors gave final approval to the manuscript.

Compliance with ethical standards

Conflict of interest

All the authors declare no conflicts of interests.

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Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  • Ting-An Lin
    • 1
  • Jyh-Pyng Gau
    • 1
    • 2
  • Yao-Chung Liu
    • 1
    • 2
    Email author
  • Po-Shen Ko
    • 1
    • 2
  • Hao-Yuan Wang
    • 1
    • 2
  • Sheng-Hsuan Chien
    • 2
    • 3
  • Chia-Jen Liu
    • 1
    • 2
  • Liang-Tsai Hsiao
    • 1
    • 2
  • Tzeon-Jye Chiou
    • 2
    • 3
  • Jin-Hwang Liu
    • 1
    • 2
    • 4
  1. 1.Division of Hematology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
  2. 2.Faculty of MedicineNational Yang-Ming UniversityTaipeiTaiwan
  3. 3.Division of Transfusion MedicineTaipei Veterans General HospitalTaipeiTaiwan
  4. 4.Division of Hematology and Oncology, Department of MedicineTaipei Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationNew Taipei CityTaiwan

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