Titre du document / Document title

Central nervous system dysfunction as the first manifestation of multiple organ dysfunction syndrome in stem cell transplant patients

Auteur(s) / Author(s)

GORDON B. ⁽¹⁾ ; LYDEN E. ⁽²⁾ ; LYNCH J. ⁽²⁾ ; TARANTOLO S. ⁽³⁾ ; PAVLETIC Z. S. ⁽³⁾ ; BISHOP M. ⁽³⁾ ; REED E. ⁽³⁾ ; KESSINGER A. ⁽³⁾ ; HAIRE W. ⁽³⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, ETATS-UNIS
⁽²⁾ Department of Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, ETATS-UNIS
⁽³⁾ Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, ETATS-UNIS

Résumé / Abstract

Development of CNS dysfunction in the setting of hematopoietic stem cell transplant (HSCT) has been previously shown to predict for subsequent second organ dysfunction and death. In this paper, we describe the characteristics of this isolated CNS dysfunction, and its relationship to multiple organ dysfunction syndrome (MODS) after HSCT. Twenty-one of 186 patients undergoing HSCT developed CNS dysfunction as their first organ dysfunction a mean of 22.8±0.9 days after the start of the preparative regimen. Compared with 137 patients who developed no organ dysfunction, patients presenting with CNS dysfunction were more likely to have undergone allogeneic HSCT (P = 0.001) and to have received a total body irradiation-based regimen (P = 0.001), and were less likely to have been transplanted for lymphoma (P = 0.008). Patients who developed CNS dysfunction were more likely to die than those with no organ dysfunction (P < 0.001). Of the 21 patients who developed CNS dysfunction, 48% resolved their dysfunction by a mean of 4.6 days later without progression to second organ dysfunction, and 90% of these patients survived to day 100. Fifty-two percent of patients with CNS dysfunction progressed to second organ dysfunction (pulmonary or hepatic) a mean of 5.5 days later, and only 36% survived to day 100 (P = 0.02). The patients who progressed to second organ dysfunction and those who did not were not different in terms of type of HSCT (allogeneic vs autologous), stem cell source (blood vs bone marrow), age, diagnosis or preparative regimen. Development of CNS dysfunction in the setting of HSCT, as with other organ dysfunctions (such as hepatic veno-occlusive disease), probably represents an early manifestation of a systemic disorder predisposing for MODS, increasing the risk of trans-plant-related mortality. Early systemic therapies directed at modulating this systemic disorder are probably indicated.

Revue / Journal Title

Bone marrow transplantation   ISSN 0268-3369   CODEN BMTRE9 

Source / Source

2000, vol. 25, n^o1, pp. 79-83 (25 ref.)

Langue / Language

Anglais

Editeur / Publisher

Nature Publishing Group , Basingstoke, ROYAUME-UNI  (1986) (Revue)

Mots-clés anglais / English Keywords

Homograft ; Autograft ; Hematopoietic cell ; Stem cell ; Bone marrow ; Blood ; Multiple organ failure ; Central nervous system disease ; Early stage ; Predictive value ; Complication ; Human ; Graft ;

Mots-clés français / French Keywords

Homogreffe ; Autogreffe ; Cellule hématopoïétique ; Cellule souche ; Moelle osseuse ; Sang ; Insuffisance organique multiple ; Système nerveux central pathologie ; Stade précoce ; Valeur prédictive ; Complication ; Homme ; Greffe ;

Mots-clés espagnols / Spanish Keywords

Homoinjerto ; Autoinjerto ; Célula hematopoyética ; Célula primitiva ; Médula ósea ; Sangre ; Insuficiencia orgánica múltiple ; Sistema nervosio central patología ; Estadio precoz ; Valor predictivo ; Complicación ; Hombre ; Injerto ;

Localisation / Location

INIST-CNRS, Cote INIST : 21176, 35400008685951.0130