1521. Central Nervous System (CNS) Complications after Hematopoietic Stem Cell Transplantation (HSCT)
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • CNS poster edited final.pdf (792.4 kB)
  • Background: CNS complications after HSCT have been described as important cause of treatment related morbidity and mortality. CNS infections are of major concern as early diagnosis and management may affect outcome. Data on incidence and outcome of CNS complications after HSCT are scarce.

    Methods: A retrospective single center study was conducted at our institution. We collected data on demographics, incidence, type of CNS complications, and outcome in HSCT pts between 1/1/2010 and 12/30/2011. CNS complications were defined as clinical neurologic manifestations along with abnormal brain imaging studies and/or documented cerebrospinal fluid abnormalities.

    Results: A total of 1584 pts underwent HSCT during that period of time including 797 auto- and 787 allo-HSCT. Overall incidence of CNS complications was 9% (146 pts). Among pts with identifiable etiology (86), the most common was vascular complications including bleeding and infarction in 42 pts (29%), CNS relapse of underlying malignancy in 19 (13%), infections in 16 (11%) and posterior reversible encephalopathy syndrome (PRES) in 6 (4%). Overall incidence of infectious complications was 1%, mainly in allo-HSCT (15 pts, 94%) with mean onset of 244 d after HSCT (range: 23-372 d) and with 25% 30-d mortality. Vascular complications occurred in 3% of mainly allo-HSCT (35 pts, 83%) with mean onset of 160 d after HSCT (range: 3-579 d) and carried a 56% 30-d mortality. PRES occurred in 5/6 pts (83%) after allo-HSCT with mean onset of 45 d and with 0% 30-d mortality. Most common infectious complications were viral CNS infections (8) including HSV-2, VZV, HHV-6, EBV, and WNV followed by nocardiosis (3), toxoplasmosis (2), brain abscess (2) and invasive aspergillosis (1). Most of these infections occurred after d 100 with mean onset of 283 d for viral infection, 217 d for nocardia and 101 d for toxoplasmosis. Nocardia infection had lower mortality rate (33%) when compared to viral infections (50%) and toxoplasmosis (50%).

    Conclusion: CNS Infections after HSCT are not common but carry a high mortality rate. Whether these infections were preventable still needs to be determined. Interestingly, vascular complications were more common and had higher mortality rate and earlier onset then CNS infections.

    Jakapat Vanichanan, MD1, Yago Nieto, MD2, Victor E. Mulanovich, MD1, Ella Ariza-Heredia, MD1, Gabriela Rondon, MD2, Dimitrios Kontoyiannis, MD, ScD, FIDSA3 and Roy F. Chemaly, MD, MPH, FIDSA, FACP1, (1)Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, (2)Stem Cell Transplantation Research, The University of Texas MD Anderson Cancer Center, Houston, TX, (3)The University of Texas M.D. Anderson Cancer Center, Houston, TX

    Disclosures:

    J. Vanichanan, None

    Y. Nieto, None

    V. E. Mulanovich, None

    E. Ariza-Heredia, None

    G. Rondon, None

    D. Kontoyiannis, None

    R. F. Chemaly, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.