Incidence, Risk Factors, and Outcome of Transplant‐Related Intra‐Cranial Hemorrhage in Pediatric Thalassemia Major Patients

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Abstract
Background: Central nervous system (CNS) complications after bone marrow transplant (BMT) for benign hematological diseases mainly Thalassemia major have a major impact on overall survival, disease‐free survival, and transplant‐related mortality. Method: Retrospective data analysis of 595 patients after first matched‐related BMT in four participating centers in the subcontinent from 2010 to 2023 was done to assess the incidence, associated risk factors and outcome of transplant‐related intracranial hemorrhage (ICH). Result: The mean age of the patient population at transplant was 8.32 ± 4.09 years. The incidence of ICH was 4.7%. ICH presented with headache (60%) and hypertension (57%) mostly in the early post‐transplant period (< 28 days post‐BMT). Age at transplant was the positive predictor of developing ICH after BMT. Transplant‐related mortality and rejection was higher in patients with ICH than in the other patients. The overall survival and disease‐free survival of 28 patients with ICH out of 595 patients was 51% and 37%, respectively, as compared to 88% and 76% in the rest of the patients. Transplant‐related mortality was higher in patients with ICH than in the other patients, but there was no statistically significant difference in rejection between the two groups. Conclusion: Transplant‐related ICH affects the overall survival, disease‐free survival, and transplant‐related mortality. ICH presented early post‐BMT with headache and hypertension. Age at BMT was the main predictor that emerged at the time of developing ICH.

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