异基因造血干细胞移植后中枢神经系统并发症的临床特征分析

Analysis of the clinical features of central nervous system complications after allogeneic hematopoietic stem cell transplantation

目的 探讨异基因造血干细胞移植(allo-HSCT)后发生中枢神经系统(CNS)并发症的危险因素及对患者生存的影响。方法 回顾性分析2018年4月-2021年12月在徐州医科大学附属医院行allo-HSCT的171例患者的临床资料,对发生CNS并发症患者的临床资料进行统计学描述,分析发生CNS并发症的危险因素,并进行生存分析。结果 171例allo-HSCT患者中19例发生CNS并发症,中位发生时间为118(3~826)d,其中9例为脑血管并发症(脑出血5例,脑梗死4例),中枢复发2例,中枢感染2例,移植相关血栓性微血管病1例,代谢性脑病1例,慢性中枢神经系统移植物抗宿主病1例,病因不明确3例。临床表现为头痛、癫痫发作及意识障碍等。单因素分析结果显示巨核系及粒系重建情况为allo-HSCT后发生CNS并发症的影响因素(P<0.05);多因素分析结果显示巨核系未重建为allo-HSCT后发生CNS并发症的危险因素(P<0.05);生存分析结果显示发生CNS并发症的患者1年和2年总生存率均低于未发生CNS并发症的患者(P<0.001),1年和2年无病生存率均低于未发生CNS并发症的患者(P<0.001),1年和2年非复发死亡率均明显高于未发生CNS并发症的患者(P<0.001)。结论 巨核系未重建是allo-HSCT后发生CNS并发症的独立危险因素,发生CNS并发症的患者总生存率及无病生存率显著低于未发生CNS并发症的患者,发生CNS并发症的患者往往预后不良。

Objective To explore the risk factors for central nervous system(CNS)complications after allogeneic hematopoietic stem cell transplantation(allo-HSCT)and their impact on patient survival.Methods The clinical data of 171 patients who underwent allo-HSCT in the Affiliated Hospital of Xuzhou Medical University from April 2018 to December 2021 were retrospectively analyzed.The clinical data of the above patients who presented CNS complications were statistically described.The risk factors for CNS complications were analyzed,and survival analysis was performed.Results CNS complications occurred in 19 of 171 allo-HSCT patients,with a median time to occurrence of 118(3-826)days,including 9 cases of cerebrovascular complications(5 cases of cerebral hemorrhage and 4 cases of cerebral infarction),2 cases of central relapses,2 cases of central infection,1 case of transplantation associated thrombotic microangiopathy(TA-TMA),1 case of metabolic encephalopathy,1 case of chronic central nervous system graft versus host disease(CNS-cGVHD),and 3 cases with unclear etiology.Clinical manifestations included headache,seizures and impaired consciousness.The results of univariate analysis showed that the reconstruction of megakaryocyte and granulomatous lineages were influencing factors for CNS complications after allo-HSCT(P<0.05).According to multivariate analysis,non-reconstruction of megakaryocyte lineage was a risk factor for the development of CNS complications after allo-HSCTT(P<0.05).The survival analysis indicated that patients with CNS complications had significantly lower 1-year and 2-year overall survival(OS)than those without CNS complications(P<0.001).They also showed decreases in 1-year and 2-year disease-free survival(DFS),but increases in 1-year and 2-year non-recurrent mortality(NRM),compared with those without CNS complications(P<0.001).Conclusions Non-reconstruction of megakaryocyte lineage is the independent risk factor for CNS complications after allo-HSCT.Patients with CNS complications have significantly decreased OS and DFS compared with those without CNS complications,and patients with CNS complications often have a poor prognosis.