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

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.