Severe hypertension is an independent risk factor for posterior reversible encephalopathy syndrome post-hematopoietic cell transplantation in children with thalassemia major.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is an increasingly recognized serious complication of Cyclosporine A (CSA) and tacrolimus (TAC) use in hematopoietic cell transplantation (HCT) recipients.

PROCEDURE: A retrospective study was carried out, including 84 cases of HCT for TM from January 2012 to January 2017. 11 cases were diagnosed with PRES.

RESULTS: The cumulative incidence of PRES was 13.4% (95%CI 9.7-17.2%). The median onset time of the symptoms was 63 [20, 143] days after transplantation. Lumber puncture found that CSF was normal. Univariate analysis showed that patients who received methylprednisolone (MP) (OR=10.629 95% CI, 1.360 to 83.071, p=0.024), female patients (OR=4.275, 95% CI, 1.154 to 15.843, p=0.032), patients who had severe hypertension (OR=5.162, 95% CI, 1.042 to 25.559, p=0.029) had significantly higher risks of PRES. Multivariate analysis showed that severe hypertension (hazard ratio [HR], 12.793; 95% CI, 1.477 to 110.813; P = 0.021), and Pesaro class 3 (HR, 3.367; 95% CI, 1.210 to 9.368; P = 0.020) were associated with PRES.

CONCLUSIONS: The severe hypertension is an independent risk factor for PRES post-HCT in children with thalassemia major. Patients of Pesaro class 3 may benefit from optimum control of blood pressure post-HCT for prophylaxis of PRES. This article is protected by copyright. All rights reserved.