Comparison of Pulmonary Complications after Nonmyeloablative and Conventional Allogeneic Hematopoietic Cell Transplant

Diab, Khalil; Yu, Zhangsheng; Wood, Karen L.; Shmalo, James A.; Sheski, Francis D.; Farber, Mark O.; Wilkes, David S.; Nelson, Robert P.

doi:10.1016/j.bbmt.2012.06.013

Cited by 21 publications

(9 citation statements)

References 54 publications

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“…We previously published the prevalence of BOS in this cohort to be 4.8% [17]. Previous estimates of the prevalence of BOS range from 2% to 30% and up to 30% of patients are asymptomatic at the time of meeting NIH criteria [13–15,18–22]. In the absence of routine spirometric screening, reports of disease prevalence likely underestimate the true burden of BOS, since symptomatic patients are typically already suffering from moderate-to-severe airflow obstruction [19].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Clinicopathological Correlation after Allogeneic Hematopoietic Stem Cell Transplantation: An Autopsy Series

Gazourian

Spring

Meserve

et al. 2017

Biology of Blood and Marrow Transplantation

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Pulmonary complications are a significant cause of morbidity, mortality, and resource utilization after hematopoietic stem cell transplantation (HSCT). The objective of this study was to compare antemortem clinical suspicion of pulmonary complications and postmortem findings in a modern HSCT cohort. All patients who underwent allogeneic HSCT at our institution (n = 1854) between January 1, 2000 and June 30, 2010 were reviewed and patients who died of any cause greater than 1 year after HSCT and had an unrestricted autopsy available for analysis were included. Presence of pulmonary graft-versus-host disease (GVHD) was assessed by a pathologist blinded to the autopsy report, as previously described by Yousem (1995). A total of 35 (1.9%) patients had autopsies available for review. Airway disease, vascular disease, and interstitial disease were all clinically under-recognized compared with the pathological findings on autopsy. Varying degrees of pathological changes were detected, including 10 (28.6%) patients having bronchiolitis obliterans (BO) and 12 (34.3%) patients having pulmonary veno-occlusive disease (PVOD). Pulmonary manifestations of chronic GVHD, particularly BO and PVOD, were clinically under-recognized in our cohort. Our results suggest that PVOD, which has traditionally been considered a rare complication, may be clinically and histologically under-recognized.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Clinicopathological Correlation after Allogeneic Hematopoietic Stem Cell Transplantation: An Autopsy Series

Gazourian

Spring

Meserve

et al. 2017

Biology of Blood and Marrow Transplantation

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“…7 The main reason for admission to our ICU was severe respiratory failure as nearly twothirds of our patients required a ventilatory support, in accordance with previous reports. 17,18 Our population was associated with a high critical illness, as reflected by the level of severity scores, and Figure 2. SAPS-II score evolution during ICU stay from day 1 to day 7.…”

Section: Discussionmentioning

confidence: 99%

A reappraisal of ICU and long-term outcome of allogeneic hematopoietic stem cell transplantation patients and reassessment of prognosis factors: results of a 5-year cohort study (2009–2013)

Platon¹,

Amigues²,

Céballos

et al. 2015

Bone Marrow Transplant

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Epidemiology and prognosis of complications related to allogeneic hematopoietic stem cell transplant (HSCT) recipients requiring admission to intensive care unit (ICU) have not been reassessed precisely in the past few years. We performed a retrospective single-center study on 318 consecutive HSCT patients (2009HSCT patients ( -2013, analyzing outcome and factors prognostic of ICU admission. Among these patients, 73 were admitted to the ICU. In all, 32 patients (40.3%) died in ICU, 46 at hospital discharge (63%) and 61 (83.6%) 1 year later. Survivors had a significantly lower sequential organ failure assessment (SOFA) score, serum lactate and bilirubin upon ICU admission. Catecholamine support, mechanical ventilation (MV) and/or renal replacement therapy during ICU stay, a delayed organ support and an active graft versus host disease (GvHD) significantly worsen the outcome. By multivariate analysis, the worsening of SOFA score from days 1 to 3, the need for MV and the occurrence of an active GvHD were predictive of mortality. In conclusion, the incidence of HSCT-related complications requiring an admission to an ICU was at 22%, with an ICU mortality rate of 44%, and 84% 1 year later. A degradation of SOFA score at day 3 of ICU, need of MV and occurrence of an active GvHD are main predictive factors of mortality.

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“…However, pulmonary complications (PCs) are associated with high morbidity and mortality. Although PCs have been reported in up to 70% of HCT recipients (2)(3)(4), the epidemiology is poorly defined in this heterogeneous population.…”

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confidence: 99%

Gut Microbiota Predict Pulmonary Infiltrates after Allogeneic Hematopoietic Cell Transplantation

Harris

Morjaria

Littmann

et al. 2016

Am J Respir Crit Care Med

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Rationale: Pulmonary complications (PCs) cause significant morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HCT). Shifts in gut microbiota have been linked to HCT outcomes; however, their effect on PCs is unknown.Objectives: To investigate whether changes in gut microbiota are associated with PCs after HCT.Methods: A single-center observational study was performed on 94 patients who underwent HCT from 2009 to 2011 and who were previously enrolled in a protocol for 16S ribosomal RNA sequencing of fecal microbiota. The primary endpoint, PC, was defined by new abnormal parenchymal findings on chest imaging in the setting of respiratory signs and/or symptoms. Outcomes were collected up to 40 months after transplant. Clinical and microbiota risk factors for PCs and mortality were evaluated using survival analysis.Measurements and Main Results: One hundred twelve PCs occurred in 66 (70.2%) subjects. A high comorbidity index (hazard ratio [HR], 2.30; 95% confidence interval [CI], 1.30-4.00; P = 0.004), fluoroquinolones (HR, 2.29, 95% CI, 1.32-3.98; P = 0.003), low baseline diversity (HR, 2.63; 95% CI, 1.22-5.32; P = 0.015), and g-proteobacteria domination of fecal microbiota (HR, 2.64; 95% CI, 1.10-5.65; P = 0.031), which included common respiratory pathogens, predicted PCs. In separate analyses, low baseline diversity was associated with PCs that occurred preengraftment (HR, 6.30; 95% CI, 1.42-31.80; P = 0.016), whereas g-proteobacteria domination predicted PCs postengraftment (HR, 3.68; 95% CI, 1.49-8.21; P = 0.006) and overall mortality (HR, 3.52; 95% CI, 1.28-9.21; P = 0.016). Postengraftment PCs were also independent predictors of death (HR, 2.50; 95% CI, 1.25-5.22; P = 0.009).Conclusions: This is the first study to demonstrate prospective changes in gut microbiota associated with PCs after HCT. Postengraftment PCs and g-proteobacteria domination were predictive of mortality. This suggests an adverse relationship between the graft and lung, which is perhaps mediated by bacterial composition in the gut. Further study is warranted.Keywords: stem cell transplantation; microbiota; pulmonary disease Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative therapy for many blood disorders and malignancies. Advances in transplant management have greatly improved outcomes (1). However, pulmonary complications (PCs) are associated with high morbidity and mortality. Although PCs have been reported in up to 70% of HCT recipients (2-4), the epidemiology is poorly defined in this heterogeneous population.Lung injury after HCT can occur early or late, present as acute or chronic, and involve one or more anatomic

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Comparison of Pulmonary Complications after Nonmyeloablative and Conventional Allogeneic Hematopoietic Cell Transplant

Cited by 21 publications

References 54 publications

Pulmonary Clinicopathological Correlation after Allogeneic Hematopoietic Stem Cell Transplantation: An Autopsy Series

Pulmonary Clinicopathological Correlation after Allogeneic Hematopoietic Stem Cell Transplantation: An Autopsy Series

A reappraisal of ICU and long-term outcome of allogeneic hematopoietic stem cell transplantation patients and reassessment of prognosis factors: results of a 5-year cohort study (2009–2013)

Gut Microbiota Predict Pulmonary Infiltrates after Allogeneic Hematopoietic Cell Transplantation

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