RESUMO
OBJECTIVES: Major complications affecting the central nervous system (CNS) present a challenge after allogeneic stem cell transplantation (allo-SCT). METHODS: Incidence, risk factors, and outcome were retrospectively analyzed in 888 patients in a monocentric study. RESULTS: Cumulative incidence (CI) of major CNS complications at 1 year was 14.8% (95%CI 12.3%-17.2%). Median follow-up is 11 months. CNS complications were documented in 132 patients: in 36 cases, classified metabolic; 26, drug-related neurotoxicity (14 attributed to cyclosporine A, 4 to antilymphocyte globulin); 11, cerebrovascular (ischemic n = 8, bleeding n = 3); 9, infections; 9, psychiatric; and 9, malignant. The cause of CNS symptoms remained unclear for 37 patients (28%). Multivariate analysis demonstrated an association of CNS complication with patient age (P < .001). The estimated OS of patients with any CNS complication was significantly lower than in patients without neurological complications (P < .001), and the CI of non-relapse mortality (NRM) was higher for patients with CNS complication (P < .001). A significant negative impact on survival can only be demonstrated for metabolic CNS complications and CNS infections (NRM, P < .0001 and P = .0003, respectively), and relapse (P < .0001). CONCLUSION: CNS complications after allo-SCT are frequent events with a major contribution to morbidity and mortality. In particular, the situations of unclear neurological complications need to be clarified by intensive research.
Assuntos
Doenças do Sistema Nervoso Central/epidemiologia , Doenças do Sistema Nervoso Central/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Adulto , Doenças do Sistema Nervoso Central/diagnóstico , Suscetibilidade a Doenças , Feminino , Transplante de Células-Tronco Hematopoéticas/métodos , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Humanos , Incidência , Masculino , Morbidade , Mortalidade , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Transplante HomólogoAssuntos
COVID-19/imunologia , Transplante de Células-Tronco Hematopoéticas , Imunossupressores/efeitos adversos , SARS-CoV-2/patogenicidade , Idoso , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/virologia , Teste para COVID-19 , Estudos de Casos e Controles , Cuidados Críticos , Estado Terminal , Feminino , Alemanha/epidemiologia , Rejeição de Enxerto/prevenção & controle , Humanos , Imunocompetência , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/isolamento & purificaçãoRESUMO
Acute regulation of adrenocorticotropic hormone (ACTH) in cerebrospinal fluid (CSF) by the hypothalamic-pituitary-adrenocortical system has not been investigated in man. In a pilot study in healthy male volunteers we measured ACTH every twenty minutes in serial CSF for three hours after an intravenous placebo, hydrocortisone (100mg) or insulin (2mg/kg) injection. No acute inhibitory or stimulatory effects of these interventions were discovered. Our results corroborate previous findings in rhesus monkeys. The regulation of CSF ACTH and its potential relevance for behavioral alterations in health and disease (e.g. major depression or anorexia nervosa) in humans need further study.
Assuntos
Hormônio Adrenocorticotrópico/líquido cefalorraquidiano , Anti-Inflamatórios/farmacologia , Hidrocortisona/farmacologia , Hipoglicemiantes/farmacologia , Sistema Hipotálamo-Hipofisário/metabolismo , Insulina/farmacologia , Sistema Hipófise-Suprarrenal/metabolismo , Hormônio Adrenocorticotrópico/efeitos dos fármacos , Adulto , Anti-Inflamatórios/administração & dosagem , Voluntários Saudáveis , Humanos , Hidrocortisona/administração & dosagem , Hipoglicemiantes/administração & dosagem , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Insulina/administração & dosagem , Masculino , Projetos Piloto , Sistema Hipófise-Suprarrenal/efeitos dos fármacos , Adulto JovemRESUMO
Corticotropin-releasing hormone (CRH) in cerebrospinal fluid (CSF) is regarded as index of brain endocrine and behavioral functioning. We investigated the acute effects of intravenous cortisol (100mg) vs. placebo on serial CSF CRH in ten healthy men. CSF CRH concentrations were not significantly suppressed by cortisol within 3h. The origin and regulation of CSF CRH need further research.