Intracranial Hemorrhage and Mortality In 1461 Patients After Allogeneic Hematopoietic Stem Cell Transplantation For 6-Year Follow-Up: Study Of 44 Cases

Although cerebral complications and causes after allogeneic hematopoietic stem cell transplantation (allo-HSCT) were well documented, assessment of incidence rates and risk factors of intracranial hemorrhage (ICH) following allo-HSCT are less discussed. The clinical data of 1461 consecutive patients undergoing allo-HSCT in Peking University Institute of Hematology from January 2005 to June 2011 were retrospectively analyzed. Among these patients, 44 developed intracranial hemorrhage (ICH) and matched 176 patients control subjects were accrued. ICH was verified by computed tomography (CT) scan in all patients. Among the 1461 patients, 44 patients (3.0 %) developed ICH, including 29 patients (65.9%) with multiple location hemorrhage, 4 patients (9.1 %) with subdural hematoma (SDH), 8 patients (18.2%) with subarachnoid hemorrhage (SAH), and 3 patients (6.8%) with other hemorrhage in the brain parenchyma. The median time of appearance for ICH was 129 days (1-450). Survival after 6 year was significantly reduced in patients who developed ICH complications compared with control (47.1% vs. 75.7%,p<0.001 ).Multivariate analysis showed that donor type, systemic infections, III-IV aGVHD, platelet count, fibrinogen level were the independent risk factors for ICH among allo-HSCT patients. The ROC curve analysis showed a cutoff value of 13.2×10⁹/L for platelet count and 129.5 g/L for fibrinogen level in patients with ICH. The transplantation-related mortality rate in the ICH and control group were 50% and 22.2%, respectively(p<0.001).ICH is common cerebral complication after allo-HSCT which associated with high mortality and decreased overall survival rate. After allo-HSCT patients with severe thrombocytopenia plus low level of fibrinogen and/or III-IV aGVHD appeared to be at particularly high risk of ICH.