A study published in the International Journal of Hematology found that the incidence of cerebrovascular disease (CVD) was approximately 10 times higher in patients after allogeneic hematopoietic stem cell transplantation (HSCT) compared with the general Taiwanese population. Moreover, CVD was associated with the number of high-dose cytarabine courses given.
The researchers retrospectively evaluated clinical data from adult patients who underwent HSCT at an Asian tertiary medical center between January 2003 and December 2015. The study aimed to estimate CVD incidence, identify associated host-related and transplant procedure-related risk factors, and measure clinical outcomes (overall survival [OS] and disease-free survival [DFS]).
Data from 459 adult allogeneic HSCT recipients were assessed. Of this patient cohort, 4.4% (20/459) developed post-transplant CVD, 2.4% (11/459) had intracranial hemorrhage (ICH), and 2.2% (10/459) had cerebrovascular infarction. Median follow-up was 22.1 months (range, 0.17-172.7). All CVD events occurred within 2 years post-HSCT.
The 2-year incidences of post-transplant CVD, ICH, and cerebrovascular infarction were 34.7 (95% CI, 22.3-53.7), 19.0 (95% CI, 10.5-34.3), and 17.2 (95% CI, 9.3-32.0) per 1000 person years, respectively. Median time from HSCT to the diagnosis of CVD was 6.2 months (range, 0.5-22.7).
Only one risk factor was associated with post-transplant CVD: prior exposure to 3 or more courses of high-dose cytarabine (hazard ratio, 4.13; 95% CI, 1.24-13.76; P =.021).
Patients who developed post-transplant CVD had reduced median OS (8.0 months vs 60.6 months; P =.001) and DFS (5.1 months vs 23.1 months; P =.004) compared with patients without post-transplant CVD. After diagnosis with CVD, 80% of patients (16/20) died within 2 months. Similarly, a majority of patients with ICH (9/11) and cerebrovascular infarction (8/10) died.
The authors concluded “the occurrence of CVD after HSCT carries a grave prognosis” and that future studies should strive to identify at-risk patients for appropriate risk management.
1. Lin T-A, Gau J-P, Liu Y-C, et al. Cerebrovascular disease after allogeneic hematopoietic stem cell transplantation: incidence, risk, and clinical outcome [published online March 12, 2019]. Int J Hematol. doi:10.1007/s12185-019-02624-y