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037 _ _ |a DKFZ-2024-00581
041 _ _ |a English
082 _ _ |a 610
100 1 _ |a Sala, Elisa
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245 _ _ |a Neurologic Complications of the Central Nervous System after Allogeneic Stem Cell Transplantation: The Role of Transplantation-Associated Thrombotic Microangiopathy as a Potential Underreported Cause.
260 _ _ |a [Amsterdam]
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336 7 _ |a article
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500 _ _ |a 2024 Jun;30(6):586.e1-586.e11
520 _ _ |a 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.
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650 _ 7 |a allogeneic stem cell transplantation
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650 _ 7 |a neurological complications
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650 _ 7 |a tacrolimus
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650 _ 7 |a transplantation-associated thrombotic microangiopathy
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700 1 _ |a Neagoie, Adela M
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700 1 _ |a Lewerenz, Jan
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700 1 _ |a Saadati, Maral
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700 1 _ |a Benner, Axel
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700 1 _ |a Gantner, Andrea
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700 1 _ |a Wais, Verena
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700 1 _ |a Döhner, Hartmut
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700 1 _ |a Bunjes, Donald
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773 _ _ |a 10.1016/j.jtct.2024.03.017
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856 4 _ |u https://inrepo02.dkfz.de/record/289081/files/1-s2.0-S2666636724002902-main.pdf
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