Abstract Number: PB0092
Meeting: ISTH 2020 Congress
Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapy for many hematological disorders. Recently, there have been new insights into the pathophysiology of stroke.
Aims: Here, we conducted a retrospective nested case-control study to investigate the incidence, clinical characteristics, risk factors and transplant outcomes of stroke following allo-HSCT.
Methods: A total of 6123 consecutive patients received allo-HSCT at Peking University People’s Hospital from 2007 to 2018. Patients diagnosed with stroke were enrolled in our study, including hemorrhagic and ischemic stroke.
Results: Overall, 2.3% of patients were diagnosed with stroke after allo-HSCT (hemorrhagic: 1.0%, ischemic: 1.3%). The median time to hemorrhagic and ischemic stroke after HSCT was 161 days and 137 days. In total, 8.4% of patients experienced neurological sequelae. The stroke led to death in 25.9% of patients. The cumulative incidence of 11-year relapse was 30.8% and 24.1% in patients with and without stroke. The incidence of relapse was comparable between the two groups. The 11-year cumulative incidence of overall survival (OS) for patients diagnosed with stroke was 26.8% compared with 46.5% in the control group. OS was much worse in patients with stroke than in control patients (p < 0.001). The cumulative incidence of transplant-related mortality (TRM) at 11 years was 28.9% and 54.1% for patients with and without stroke (p < 0.001). Our analysis showed that significant independent risk factors for the occurrence of stroke were high risk disease, acute lymphoblastic leukemia (ALL), central nervous system leukemia, grade III-IV acute graft-versus-host disease (aGVHD), thrombotic microangiopathy (TMA), and delayed platelet engraftment. Using these risk factors, a risk score model was constructed to predict the risk of stroke after allo-HSCT (Figure).
Conclusions: Stroke is a relatively significant and life-threatening complication after allo-HSCT. The risk score model provides a practical tool to predict the risk of stroke.
To cite this abstract in AMA style:Cai X, Fu H-, Mo X-, Wang Y, Zhang Y-, Wu J, Han W, Tang F-, Gui R-, Chen H, Chen Y, Zhao P, Yan C-, Wang J-, Chen Y-, Chang Y-, Xu L-, Liu K-, Huang X-, Zhang X-. Hemorrhagic and Ischemic Stroke in Patients after Allogeneic Stem Cell Transplantation [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/hemorrhagic-and-ischemic-stroke-in-patients-after-allogeneic-stem-cell-transplantation/. Accessed January 28, 2022.
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