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

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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.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan

    Ting-An Lin, Jyh-Pyng Gau, Yao-Chung Liu, Po-Shen Ko, Hao-Yuan Wang, Chia-Jen Liu, Liang-Tsai Hsiao & Jin-Hwang Liu

  2. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan

    Jyh-Pyng Gau, Yao-Chung Liu, Po-Shen Ko, Hao-Yuan Wang, Sheng-Hsuan Chien, Chia-Jen Liu, Liang-Tsai Hsiao, Tzeon-Jye Chiou & Jin-Hwang Liu

  3. Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Sheng-Hsuan Chien & Tzeon-Jye Chiou

  4. Division of Hematology and Oncology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan

    Jin-Hwang Liu

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  1. Ting-An Lin
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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.

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Correspondence to Yao-Chung Liu.

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Lin, TA., Gau, JP., Liu, YC. et al. Cerebrovascular disease after allogeneic hematopoietic stem cell transplantation: incidence, risk, and clinical outcome. Int J Hematol 109, 584–592 (2019). https://doi.org/10.1007/s12185-019-02624-y

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  • DOI: https://doi.org/10.1007/s12185-019-02624-y

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