Impact of pre-transplant pulmonary infection developed in horizontal laminar flow unit on the outcome of subsequent allogeneic hematopoietic stem cell transplantation

Abstract

Background: So far, there is very little literature on how pre-transplant pulmonary infection developed in horizontal laminar flow unit (HLFU) affects outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods: A retrospective analysis was performed on allo-HSCT recipients who were diagnosed with pretransplant pulmonary infection developed in HLFU between January 2012 and December 2012. Various tests were analyzed to evaluate the overall survival (OS) and pulmonary infection rate after allo-HSCT.Results: Among 317 patients who received allo-HSCT from related donors, 7 cases of human leukocyte antigen (HLA)-haploidentical transplantation reported a fever, cough, and other symptoms before transplantation. Chest radiography findings showed pulmonary infection, and the C-reactive protein (CRP) level was higher than normal, which confirmed pulmonary infection (incidence rate 2.21%). The Breslow test suggested that the early survival rate was lower in the group with pre-transplant pulmonary infection than in the group without pre-transplant pulmonary infection (OS: 28.4 vs. 42.4 months; P=0.023); the early survival rate was lower in patients with a pulmonary infection accompanied by bilateral pleural effusion than in patients without pleural effusion (OS: 1.5 vs. 36.3 months; P=0.010). In the first month after transplantation, the difference in the CD4CD45RO+CD45RA-and CD4CD45RO-CD45RA+ between the groups with and without pre-transplant pulmonary infection was statistically significant (P<0.05). Patients with pre-transplant pulmonary infection who survived >3 years had a higher rate of pulmonary infection in the first 2 months after allo-HSCT than those without pre-transplant pulmonary infection [100% (5/5 patients) vs. 38.1%(118/310); χ 2 =5.542, P=0.019].Conclusions: Development of pre-transplant pulmonary infection in the HLFU in patients with hematological malignancies who receive HLA-haploidentical HSCT is associated with an increased risk of recurrent pulmonary infection in the early period after transplantation; however, there is no impact on patients' long-term survival rate.

Pulmonary Infection Within 100 Days After Transplantation Impaired Platelet Recovery in Patients with Hematologic Malignancies: A Propensity-Score-Matched Analysis

“…Despite the advances in prophylaxis and therapy of infections, pulmonary infections remain a major cause of death in more than 40% of alloHSCT recipients [27–29]. In the present retrospective study, we identified 62 cases of pulmonary infection (62/253, 25%) during the transplant procedure, in which pneumonia was diagnosed based on clinical symptoms, microbial culture, biochemical assay, invasive diagnostic procedures, and imaging results.…”

Pair-matched study of cryopreserved versus native graft in adult and pediatric recipients of allogeneic hematopoietic stem cell transplantation

“…It is well known that grafting in relapse is the worst predictive factor for long-term survival [2]. On the other hand, active infections at the start of the conditioning also impact the outcome adversely [3,4]. Thus in the majority of cases like these the decision is made to postpone the HSCT, however this is not possible in certain situations with unrelated donors, and also when a related donor has started the stimulation with granulocyte-colony stimulating factor.…”