Early predictors of mortality in children with pulmonary complications after haematopoietic stem cell transplantation

Choi, Yu Hyeon; Jeong, Hyung Joo; An, Hong Yul; Kim, You Sun; Lee, Eui Jun; Lee, Bong Jin; Kang, Hyoung Jin; Shin, Hee Young; Park, June Dong

doi:10.1111/petr.13062

Cited by 6 publications

(1 citation statement)

References 52 publications

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“…By the time patients get symptomatic, this indicates an advanced stage of the disease with high mortality. Pulmonary function tests are the standard exams realized to detect BOS in patients, but due to their cost and inconvenience, it makes it difficult for programs to implement [ 31 ].…”

Section: Reviewmentioning

confidence: 99%

A Systematic Review on Pulmonary Complications Secondary to Hematopoietic Stem Cell Transplantation

Busmail¹,

Penumetcha²,

Ahluwalia³

et al. 2022

Cureus

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The main purpose of this systematic review was to identify and synthesize evidence about pulmonary complications following stem cell transplantation to raise awareness among physicians since it is a lesser-known topic. Studies that included targeted pulmonary complications that occurred after stem cell transplantation; in humans; and were randomized controlled trials, cohort studies, and case studies between January 2011 and 2021. Fifteen intervention features were identified and analyzed in terms of their association with successful or unsuccessful interventions. Fifteen of 15 studies that met inclusion criteria had positive results. Features that appeared to have the most consistent positive effects included relevant information consisting of clinical presentations and management of complications. Hematopoietic stem cell transplantation is a therapeutic method that has been introduced for various hematological diseases. Its main objective is to restore the hematopoietic function that has been eradicated or affected. The stem cell transplantation requires a period of administration of chemotherapeutic agents that may lead to infectious and/or non-infectious pulmonary complications that require follow-up. Noninfectious pulmonary complications include bronchiolitis obliterans, alveolar hemorrhage, fibroelastosis, pulmonary hypertension, and infections. Bronchiolitis obliterans syndrome is an obstructive lung disease that affects the small airways, reducing lung function, and it’s the most frequent late-onset complication. Furthermore, diffuse pulmonary hemorrhage is a fatal adverse effect and the most common noninfectious pulmonary complication of acute leukemia, observed within the first weeks after the procedure. Pulmonary hypertension has multiple etiologies, mainly related to the pulmonary veno-occlusive disease. It carries a poor prognosis, with a 55% mortality rate. The area of hematology is very wide and prone to new development of treatments and procedures that could be available for new emerging diseases and improving survival rates.

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Section: Reviewmentioning

confidence: 99%

A Systematic Review on Pulmonary Complications Secondary to Hematopoietic Stem Cell Transplantation

Busmail¹,

Penumetcha²,

Ahluwalia³

et al. 2022

Cureus

View full text Add to dashboard Cite

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Biomarkers to predict and diagnose pulmonary complications in children post haematopoietic stem cell transplant

Walker,

Haeusler,

Cole

et al. 2024

Clin & Trans Imm

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Objectives. Haematopoietic cell transplant (HCT) is a cellular therapy for a group of high‐risk children with cancer, immunodeficiency and metabolic disorders. Whilst curative for a child's underlying condition, HCT has significant risks associated, including lung injury. These complications are associated with increased post HCT mortality and require improved methods of risk stratification, diagnosis and treatment. Methods. Biomarkers measured in bronchoalveolar fluid and peripheral blood have been identified for both acute and chronic lung injury post HCT.This review evaluates the current research available investigating the use of these biomarkers to improve clinical care, with a focus on the paediatric cohort. Results. Elevated levels of cytokines such as IL‐6, IL‐8, G‐CSF and TNF were identified as potential predictive biomarkers for the development of post HCT lung disease. The pulmonary microbiome was found to have strong potential as a biomarker pre and post HCT for the development of pulmonary complications. General limitations of the studies identified were study design, retrospective or single centre and not exclusively performed in the paediatric population. Conclusion. To translate biomarker discovery into clinical implementation further research is required, utilising larger cohorts of children in prospective trials to validate these biomarkers and determine how they can be translated into better outcomes for children post HCT.

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Pulmonary complications post allogeneic haematopoietic stem cell transplant in children

Walker,

Abbotsford,

Haeusler

et al. 2024

Clin & Trans Imm

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ObjectivesHaematopoietic stem cell transplant (HCT) is a cellular therapy that, whilst curative for a child's underlying disease, carries significant risk of mortality, including because of pulmonary complications. The aims of this study were to describe the burden of pulmonary complications post‐HCT in a cohort of Australian children and identify risk factors for the development of these complications.MethodsPatients were identified from the HCT databases at two paediatric transplant centres in Australia. Medical records were reviewed, and demographics, HCT characteristics and pulmonary complications documented. Relative risk ratio was used to identify risk factors for developing pulmonary complications prior to first transplant episode, and survival analysis performed to determine hazard ratio.ResultsIn total, 243 children underwent transplant during the study period, and pulmonary complications occurred in 48% (117/243) of children. Infectious complications were more common (55%) than non‐infective complications (18%) and 26% of patients developed both. Risk factors for the development of pulmonary complications included the following: diagnoses of MPAL (RR 2.16, P = 0.02), matched unrelated donor (RR1.34, P = 0.03), peripheral blood (RR 1.36, P = 0.028) or cord blood (RR 1.73, P = 0.012) as the stem cell source and pre‐existing lung disease (RR1.72, P < 0.0001). Children with a post‐HCT lung complication had a significantly increased risk of mortality compared with those who did not (HR 3.9, P < 0.0001).ConclusionThis study demonstrates pulmonary complications continue to occur frequently in children post‐HCT and contribute significantly to mortality. Highlighting the need for improved strategies to identify patients at risk pre‐transplant and enhanced treatments for those who develop lung disease.

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Early predictors of mortality in children with pulmonary complications after haematopoietic stem cell transplantation

Cited by 6 publications

References 52 publications

A Systematic Review on Pulmonary Complications Secondary to Hematopoietic Stem Cell Transplantation

A Systematic Review on Pulmonary Complications Secondary to Hematopoietic Stem Cell Transplantation

Biomarkers to predict and diagnose pulmonary complications in children post haematopoietic stem cell transplant

Pulmonary complications post allogeneic haematopoietic stem cell transplant in children

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