Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental Neurology2075-54732409-2533Research Center of Neurology90910.54101/ACEN.2023.1.4Research ArticleCerebrovascular complications of hematopoetic stem cell transplantation in patients with hematologic malignanciesPolushinAlexey Yu.<p>Cand. Sci. (Med.), Head, Scientific and Clinical Center for Transplantation and Cell Therapy in Autoimmune and Neurodegenerative Diseases, Head, Research Laboratory of Neurooncology and Autoimmune Diseases, R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology; Associate Professor, Department of neurology, First Pavlov State Medical University</p>alexpolushin@yandex.ruhttps://orcid.org/0000-0001-8699-2482SkibaIaroslav B.<p>Cand. Sci. (Med.), Neurologist, R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, First Pavlov State Medical University</p>yaver-99@mail.ruhttps://orcid.org/0000-0003-1955-1032BakinEvgeny A.<p>Cand. Sci. (Tekh.), Senior Researcher, R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, First Pavlov State Medical University</p>eugene.bakin@gmail.comhttps://orcid.org/0000-0002-5694-4348VladovskayaMaria D.<p>Cand. Sci. (Med.), Head, Department of Hospital Registers, Senior Researcher, Research Laboratory of Neurooncology and Autoimmune Diseases, R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, First Pavlov State Medical University</p>rus-bmt-reg@mail.ruhttps://orcid.org/0000-0002-0215-4623YakovlevaVictoria A.<p>Cand. Sci. (Med.), Neurologist, R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, First Pavlov State Medical University</p>24ro80@gmail.comhttps://orcid.org/0000-0002-9839-3169MoiseevIvan S.<p>D. Sci, (Med.), Hematologist, Deputy Director for Scientific Work, R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, Professor, B.V. Afanasyev Department of Hematology, Transfusion Medicine and Transplantation with the Course of Pediatric Oncology, First Pavlov State Medical University</p>moisiv@mail.ruhttps://orcid.org/0000-0002-4332-0114YanishevskiyStanislav N.<p>D. Sci. (Med.), Head, Research Laboratory of Neurology and Neurorehabilitation, Professor, Department of Neurology and Psychiatry, Chief Researcher, Research Institute of Technologies for Predicting the Risk of Cardiovascular Complications, Center for Personalized Medicine, V.A. Almazov National Medical Research Center; Associate professor, Department of Nervous Diseases, S.M. Kirov Military Medical Academy</p>stasya71@yandex.ruhttps://orcid.org/0000-0002-6484-286XVoznyukIgor A.<p>D. Sci. (Med.), Professor, Department of Neurology, First Pavlov State Medical University; Professor, Department of Nervous Diseases, S.M. Kirov Military Medical Academy</p>voznjouk@yandex.ruhttps://orcid.org/0000-0002-0340-4110KulaginAlexander D.<p>D. Sci. (Med.), Professor, Director, R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, Head, B.V. Afanasyev Department of Hematology, Transfusion Medicine and Transplantation with the Course of Pediatric Oncology, First Pavlov State Medical University</p>kulagingem@rambler.ruhttps://orcid.org/0000-0002-9589-4136Pavlov First Saint Petersburg State Medical UniversityS.M. Kirov Military Medical AcademyAlmazov National Medical Research Centre2903202317127352410202221122022Copyright © 2023, Polushin A.Y., Skiba I.B., Bakin E.A., Vladovskaya M.D., Yakovleva V.A., Moiseev I.S., Yanishevskiy S.N., Voznyuk I.A., Kulagin A.D.2023<p><strong><em>Introduction.</em></strong> Modern transplantation and biological therapy methods are associated with a wide range of adverse events and complications. Incidence and variety of neurological complications mostly depend on myelo- and immunosuppression severity and duration as well as on donor's and recipient's characteristics. The most frequent complications involving the nervous system include neurotoxic reactions, infections, autoimmune and lymphoproliferative diseases, and dysmetabolic conditions as well as cerebrovascular complications that potentially affect transplantation outcomes.</p>
<p><strong><em>Objective. </em></strong>To evaluate the impact of post-transplantation cerebrovascular events (CVEs) on transplantation outcomes in patients with hematologic malignancies.</p>
<p><strong><em>Materials and methods</em></strong>. We analyzed 899 transplantations performed at the Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology, and Transplantation, Pavlov First Saint Petersburg State Medical University, from 2016 to 2018. We assessed transplantation parameters and donor's and recipient's characteristics by intergroup comparison, pseudo-randomization (propensity score matching), KaplanMeier survival analysis, and log-rank tests.</p>
<p><strong><em>Results. </em></strong>Post-transplantatively, CVEs developed in 2.6% (n = 23) of cases: 13 (1.4%) ischemic strokes and 11 (1.2%) hemorrhagic strokes or intracranial hemorrhages were diagnosed. CVEs developed on days 99.5 39.2 post hematopoetic stem cell transplantation (HSCT). There were more patients with non-malignant conditions in the CVE group as compared to the non-CVE group (21.7% vs 7.9%; p = 0.017). Patients with CVE had a significantly lower Karnofsky index (75.6 21.3 vs 85.2 14.9; p = 0.008). Statistically, we also note some non-significant trends: patients with CVE more often underwent allogenic HSCT (82.6% vs 64.0%; p = 0.077) while donors were more often partially (rather than totally) HLA compatible for recipients (39.1% vs 21.1%; p = 0.33). Patients with CVE more often had a history of venous thromboses (13.3% vs 4.2%; p = 0.077). Post-HSCT stroke decreased post-transplantation longevity by approximately 3 times (331.8 81.6 vs 897.9 25.4 post HSCT; p = 0.0001). In the CVE group, survival during first 180 days post HSCT (landmarks post-HSCT Day+60 and Day+180) was significantly lower as compared to that in the CVE-free group. If CVE developed during first 30 days and 100 days post HSCT, vascular catastrophe did not affect post-HSCT survival significantly.</p>
<p><strong><em>Conclusion</em></strong>. Whereas ischemic stroke is a long-term HSCT complication (beyond D+100 post transplantation), hemorrhagic stroke is a short-term complication (D0D+100 post HSCT). CVEs affect survival in patients with hematologic malignancies, especially those developed between D+60 and D+180 post HSCT. History of venous abnormalities, low Karnofsky index at HSCT initiation, and the type of allogenic HSCT, especially from half-matched donors, can be considered as negative outcome risk factors in post-HSCT CVE.</p>strokeischemic strokehemorrhagic strokehematological management complicationsleukemiaallogenic transplantationlong-term neurological complicationsинсультишемический инсультгеморрагический инсультосложнения лечения гематологических заболеванийлейкозаллогенная трансплантацияпродолжительные неврологические осложнения[Graus F., Saiz A., Sierra J. et al. 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