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@ARTICLE{Sala:289081,
      author       = {E. Sala and A. M. Neagoie and J. Lewerenz and M.
                      Saadati$^*$ and A. Benner$^*$ and A. Gantner and V. Wais and
                      H. Döhner and D. Bunjes},
      title        = {{N}eurologic {C}omplications of the {C}entral {N}ervous
                      {S}ystem after {A}llogeneic {S}tem {C}ell {T}ransplantation:
                      {T}he {R}ole of {T}ransplantation-{A}ssociated {T}hrombotic
                      {M}icroangiopathy as a {P}otential {U}nderreported {C}ause.},
      journal      = {Transplantation and cellular therapy},
      volume       = {30},
      number       = {6},
      issn         = {2666-6375},
      address      = {[Amsterdam]},
      publisher    = {Elsevier B. V.},
      reportid     = {DKFZ-2024-00581},
      pages        = {586.e1-586.e11},
      year         = {2024},
      note         = {2024 Jun;30(6):586.e1-586.e11},
      abstract     = {neurological complications (NC), especially those of the
                      central nervous system (CNS), represent a severe
                      complication after allogeneic stem cell transplantation
                      (allo-HSCT) and are associated with relevant morbidity and
                      mortality.we aim to characterize the potential risk factors
                      for the development of CNS-NC with a special focus on the
                      role of calcineurin inhibitors (CNI) as a predisposing
                      factor. For this purpose, we compared Cyclosporin A (CsA)
                      versus Tacrolimus (TAC) with respect to their influence on
                      the incidence and type of CNS-NC after allo-HSCT.we
                      retrospectively analyzed incidence, risk factors and impact
                      on outcome of CNS-NC diagnosed during the
                      post-transplantation follow-up in patients with different
                      high-risk hematological malignancies who underwent allo-HSCT
                      at our institution over a time frame of 20 years. All
                      patients included in the analysis received CNI (CsA or TAC)
                      as graft versus host disease (GVHD) prophylaxis.we evaluated
                      a total of 739 consecutive patients transplanted from
                      12/1999 to 04/2019. Within a median follow-up period of 6.8
                      years, we observed a CNS-NC incidence of $17\%.$ The
                      development of CNS-NC was associated with decreased overall
                      survival (OS) and increased transplant-related mortality
                      (TRM). The most frequent CNS-NC were infections $(30\%)$ and
                      neurological adverse events related to the administration of
                      CNI, TAC or CsA, as GVHD prophylaxis $(42\%).$ In the
                      multivariable analysis, age, total body irradiation (TBI)
                      and severe acute and chronic GVHD significantly impacted as
                      risk factors on the development of CNS-NC. TAC as compared
                      with CsA emerged as an independent predisposing factor for
                      CNS-NC. The TAC-associated risk of CNS-NC was mostly due to
                      the occurrence of transplant-associated thrombotic
                      microangiopathy (TA-TMA) with neurological manifestations
                      (Neuro-TA-TMA), even if the general TA-TMA incidence was
                      comparable in the two CNI subgroups.CNS-NC are associated
                      with poor prognosis after allo-HSCT with TAC emerging as a
                      potential yet insufficiently characterized predisposing
                      factor.},
      keywords     = {allogeneic stem cell transplantation (Other) / neurological
                      complications (Other) / tacrolimus (Other) /
                      transplantation-associated thrombotic microangiopathy
                      (Other)},
      cin          = {C060},
      ddc          = {610},
      cid          = {I:(DE-He78)C060-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:38508452},
      doi          = {10.1016/j.jtct.2024.03.017},
      url          = {https://inrepo02.dkfz.de/record/289081},
}