Clinical study of the nervous system complications after hematopoietic stem cell transplantation

Objective：Analyze the characteristics of nervous system (NS)complications after hematopoietic stem cell transplantation(HSCT) ,and evaluate risk factors in order to reduce its occurrence, provide better diagnosis and treatment and improve the prognosis of the patients．Methods：The clinical outcomes of the patients who developed NS complications after HSCT were collected in our hospital from August 2012 to August 2015, and retrospective analysis was used. Results：A total of 87 patients with NS complications after HSCT include central nervous system complications was 71.3% (62/87) and peripheral nerve complications was 28.7% (25/87). The types of primary disease included acute lymphoblastic leukemia (ALL) 34.5% (30/87), acute myelogenous leukemia (AML) 23.0% (20/87), chronic myelogenous leukemia (CML ) 12.6% (11/87), other types of leukemia by 9.2% (8/87), aplastic anemia 13.8% (12/87), myelodysplastic syndrome 6.9% (6/87); HLA matched 19 cases (21.8%), HLA mismatched 53 cases (60.9%), unrelated donors 15 cases (17.2%), central nervous system complication rate was 16.1%, 69.4％ and 14.5％, respectively; peripheral nerve complication rate was 36.0％， 40.0％ and 24.0％ respectively （χ2=6.682, P=0.034). The incidences of NS complications were 26.4% (23/87) in children and 73.6% (64/87)in adults respectively,and there was no significant difference in the types of NS complications (P=0.435). The cases accompanied with GVHD or infection respectively account for 69.0% (60/87) and 59.8% (52/87), and there were significant difference in the incidences of types of NS complications (P<0.05). The onset time of 87 patients with nervous system complications or peripheral nerve complications was 1726 days (median 49 days) and 20694 days (median 80 days), respectively. The overall mortality rate was 33.3% (29/87), with central nervous system complications was 93.1% (27/29), with peripheral nerve complications was 6.9% (2/29, P<0.05). Conclusions：The patients with central nervous system complications have higher incidence, higher mortality,and shorter onset time than the patients with peripheral nerve complications, and related with HLA types, GVHD and infection risk factors.