Central nervous system disorders after hematopoietic stem cell transplantation: a prospective study of the Infectious Diseases Working Party of EBMT
Por:
Schmidt-Hieber, M, Engelhard, D, Ullmann, A, Ljungman, P, Maertens, J, Martino, R, Rovira, M, Shaw, PJ, Robin, C, Faraci, M, Byrne, J, Schafer-Eckart, K, Einsele, H, Faber, E, Rigacci, L, Saccardi, R, Balaguer-Rosello, A, Isaksson, C, Christopeit, M, Tridello, G, Wang, JF, Knelange, N, Mikulska, M, Cesaro, S, Styczynski, J
Publicada:
1 feb 2020
Ahead of Print:
1 oct 2019
Resumen:
We performed a prospective study to evaluate the types and characteristics of central nervous system (CNS) disorders in patients after hematopoietic stem cell transplantation. The study included 163 episodes of CNS disorders of which 58 (36%) were infections. Proven or probable infections were documented in 34 patients and included fungi (n = 10, 29%), viruses (n = 12, 35%), Toxoplasma spp. (n = 9, 27%) and bacteria (n = 3, 9%). Non-infectious neurological disorders (n = 105, 64%) frequently encompassed metabolic/drug-induced abnormalities (n = 28, 27%) or cerebral vascular events (n = 22, 21%). Median onset times were later for infectious (day + 101) vs non-infectious neurological disorders (day + 50, p = 0.009). An unremarkable cranial CT scan was found in 33% of infection episodes. Absence of cerebrospinal fluid pleocytosis despite a normal or increased peripheral blood white blood cell count occurred in 26% of infections. Day-30 mortality rates were significantly higher for fungal (87%) vs non-fungal infections (40%, p < 0.001). Significantly higher mortality rates were also documented for cerebral vascular events than for other non-infectious disorders (86% vs 34%, p < 0.001). Our prospective study shows that diagnostic findings in CNS infections might differ between hematopoietic stem cell transplant recipients and immunocompetent hosts. Special awareness and timely initiation of adequate diagnostics are crucial to improve the prognosis of these patients.
Filiaciones:
Schmidt-Hieber, M:
Carl Thiem Klinikum, Clin Hematol & Oncol, Thiemstr 111, D-03048 Cottbus, Germany
Engelhard, D:
Hadassah Hebrew Univ Med Ctr, Dept Pediat, Jerusalem, Israel
Ullmann, A:
Univ Hosp Wurzburg, Dept Internal Med 2, Wurzburg, Germany
Ljungman, P:
Karolinska Univ Hosp, Stockholm, Sweden
Karolinska Inst, Stockholm, Sweden
Maertens, J:
Katholieke Univ Leuven, Dept Microbiol Immunol & Transplantat, Leuven, Belgium
Martino, R:
Autonomous Univ Barcelona, Hosp Santa Creu & St Pau, Barcelona, Spain
Rovira, M:
Univ Barcelona, Josep Carreras Leukemia Res Inst, Inst Hematol & Oncol, IDIBAPS,Hosp Clin,Dept Hematol, Barcelona, Spain
Shaw, PJ:
Childrens Hosp Westmead, Sydney, NSW, Australia
Robin, C:
Henri Mondor Univ Hosp, AP HP, Hematol Dept, Creteil, France
UPEC, Creteil France Hosp Henri Mondor, Creteil, France
Faraci, M:
IRCCS Inst G Gaslini, Hematopoiet Stem Cell Unit Transplantat, Genoa, Italy
Byrne, J:
Nottingham Univ Hosp, Nottingham, England
Schafer-Eckart, K:
Paracelsus Med Privatuniv, Klinikum Nurnberg, Clin Hematol & Oncol, Nurnberg, Germany
Einsele, H:
Univ Hosp Wurzburg, Dept Internal Med 2, Wurzburg, Germany
Faber, E:
Palacky Univ, Fac Hosp Olomouc, Dept Hematooncol, Fac Med & Dent, Olomouc, Czech Republic
Rigacci, L:
Osped S Camillo Roma, Rome, Italy
Saccardi, R:
Azienda Osped Univ Careggi, Florence, Italy
Balaguer-Rosello, A:
Hosp Univ & Politecn La Fe, Valencia, Spain
Isaksson, C:
Umea Univ Hosp, Umea, Sweden
Christopeit, M:
Univ Med Ctr Eppendorf, Dept Stem Cell Transplantat, Hamburg, Germany
Tridello, G:
Azienda Osped Univ Integrata, Mother & Child Hosp, Pediat Hematol Oncol, Verona, Italy
EBMT Data Off, Leiden, Netherlands
Wang, JF:
EBMT Data Off, Leiden, Netherlands
Knelange, N:
EBMT Data Off, Leiden, Netherlands
Mikulska, M:
Univ Genoa, Div Infect Dis, DISSAL, Genoa, Italy
IRCCS Osped Policlin San Martino, Genoa, Italy
Cesaro, S:
Azienda Osped Univ Integrata, Mother & Child Hosp, Pediat Hematol Oncol, Verona, Italy
Styczynski, J:
Coll Med UMK, Dept Pediat Hematol & Oncol, Bydgoszcz, Poland
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