急性脑病,临床表现为谵妄,是造血细胞移植(HCT)的常见但通常未被识别的并发症。在任何年龄的患者中发现谵妄,并在自体或同种异体HCT后观察到。虽然主要在清髓性条件受体的初次移植住院期间进行了研究,最近的HCT调查发现,移植后和接受低强度调节的患者出现谵妄.急性脑病可由感染性并发症引起,药物,组织损伤和/或器官功能障碍。意识改变了,温和或深刻,通常是其唯一的临床表现。识别谵妄对于整体HCT护理至关重要,因为发生谵妄的患者住院时间和恢复时间更长,并且有其他不良HCT后结局的风险。鉴于这种常见并发症的关键性质和HCT扩展到更脆弱的人群,美国移植和细胞治疗学会(ASTCT)建议,现在是时候加强对HCT后认知变化的研究,并为临床护理目的建立涵盖全部意识改变的标准化定义,并为未来的研究提供基准终点.为了捕获一系列特别在HCT患者中发现的急性神经认知变化(通常称为急性脑病),ASTCT提出了新的诊断,移植相关畸形和脑病(TAME)。TAME诊断包括符合DSM-5谵妄标准的HCT患者和不符合完全DSM-5谵妄标准(亚综合征谵妄)的急性神经认知改变患者。早期TAME被定义为发生在HCT后的调节过程中或≤100天,而晚期TAME发生在HCT后>100天,在有其他HCT相关并发症的患者中。本手稿将建立明确的诊断标准,并讨论可能影响TAME发展的因素,以及TAME的工作和管理。
Acute encephalopathy, manifesting clinically as delirium, is a common but often unrecognized complication of hematopoietic cell transplantation (HCT). Delirium can occur in patients of any age and is observed after autologous or allogeneic HCT. Although delirium has been studied primarily during initial HCT hospitalizations in recipients of myeloablative conditioning, recent investigations have identified delirium later post-transplantation and in recipients of reduced-intensity conditioning. Acute encephalopathy can be driven by infectious complications, medications, tissue damage, and/or organ dysfunction. Altered consciousness, either mild or profound, is often its only clinical manifestation. Identifying delirium is essential to overall HCT care, because patients who experience delirium have longer hospitalization and recovery times and are at risk for other poor post-HCT outcomes. Given the critical nature of this common complication and the ongoing expansion of HCT for more vulnerable populations, the American Society of Transplantation and Cellular Therapy (ASTCT) recommends intensifying research into post-HCT cognitive changes and establishing standardized definitions that encompass the full spectrum of altered consciousness for clinical care purposes and to provide benchmark endpoints for future research studies. To capture a range of acute neurocognitive changes specifically found in HCT patients (often referred to as acute encephalopathy), the ASTCT proposes a new diagnosis, transplantation-associated altered mentation and encephalopathy (TAME). The TAME diagnosis includes HCT patients who meet Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for delirium and those with acute neurocognitive changes who do not meet all the DSM-5 criteria for delirium (subsyndromal delirium). Early TAME is defined as occurring during conditioning or ≤100 days post-HCT, whereas late TAME occurs >100 days post-HCT in patients with additional HCT-related complications. This manuscript establishes clear diagnostic criteria and discusses factors that can potentially impact the development of TAME, as well as the workup and management of TAME.