Noninfectious lung complications after allogeneic haematopoietic stem cell transplantation

Abstract

Epidemiological data on late-onset noninfectious pulmonary complications (LONIPCs) following allogeneic haematopoietic stem cell transplantation (HSCT) are derived exclusively from retrospective studies and are conflicting. We aimed to evaluate prospectively the incidence, risk factors and outcomes for LONIPCs.All consecutive patients scheduled to receive allogeneic HSCT between 2006 and 2008 at a university teaching hospital in France were screened for inclusion in the study. Eligible patients were those surviving at day 100. Among 243 screened patients, 198 patients were included in the analysis. The median (interquartile range) follow-up was 72.3 (15.2-88.5) months. 55 LONIPCs were diagnosed in 43 patients. Bronchiolitis obliterans syndrome (n=22) and interstitial lung disease (n=12) were the most common LONIPCs. At 36 months after inclusion, the estimated cumulative incidence of LONIPCs was 19.8% (95% CI 14.2-25.3%). The estimated median survival after the diagnosis of LONIPCs was 78.5 months (95% CI 20.0-not reached). Based on a multivariate Cox model, a history of chest irradiation anytime prior to HSCT, a history of pneumonia within 100 days post-HSCT and a low mean forced expiratory flow at 25-75% of forced vital capacity at day 100 were associated with the development of LONIPCs.Our data provide clues to identify patients at high risk of developing LONIPCs. These patients should be targeted for close monitoring to provide earlier LONIPC treatment or prophylactic treatment.

Rapid versus gradual lung function decline in bronchiolitis obliterans syndrome after haematopoietic stem cell transplantation is associated with survival outcome

“…HSCT BOS patients with rapid initial decline in lung function within the first 3 months would warrant closer monitoring in the subsequent clinical course for development of further post‐HSCT complications that could affect their survival. A recent prospective study that included 22 BOS subjects among 43 patients with non‐infectious lung complications after HSCT showed that it was possible to identify BOS subjects early by means of regular lung function screening in patients after HSCT . The early detection or anticipation of lung function decline in BOS subjects may allow for the opportunity of early intervention.…”

Acute respiratory failure in immunocompromised adults

“…More over, patients with prolonged neutropenia 6 and autologous or allogeneic stem cell transplant recipients [24][25][26][27] have higher incidences of respiratory events compared with other haematology patients. Solid tumours are associated with a lower incidence of respiratory events than haematological malignancies, with lung cancer having the highest rates (up to 50%), because endobronchial obstruction and atelectasis are risk factors for pneu monia.…”

“…Similarly, conditions such as neutro penia or allogeneic haemopoietic stem cell trans plantation are associated with both a high risk of respiratory events and specific acute respiratory failure causes such as exacerbation of previous lung injury during neutropenia recovery, 57 or non-infectious interstitial lung diseases following haemo poietic stem cell transplantation. 26,58 Acute respiratory failure in the first few days after solid organ transplantation is probably related to either a Biopsy or puncture of extra-pulmonary involvement (skin, joints, peripheral lymph nodes, sternal puncture, buccal smear, etc) Imaging data, including chest X-ray, lung and pleural echography, and high-resolution CT scan (without first-line contrast media unless there is a clinical suspicion of pulmonary vascular disease) Review surgical complication or to decompensation of a chronic respiratory or cardiac comorbid condition. 34,36,59,60 Invasive candidiasis might occur quite early after transplantation.…”

Lung histopathology of non‐infectious pulmonary complications after allogeneic haematopoietic stem cell transplantation

“…Whether or not both post‐allogeneic HSCT bronchiolar pathology and interstitial lung diseases (ILDs) share the same physiopathological pathway and can coexist remains unknown. In a prospective long‐term clinical pulmonary follow‐up of allogeneic HSCT recipients, we recently reported a 3‐year cumulative incidence of 10 and 5% for BOS and ILDs, respectively …”

“…In a prospective long-term clinical pulmonary follow-up of allogeneic HSCT recipients, we recently reported a 3year cumulative incidence of 10 and 5% for BOS and ILDs, respectively. 11 There is no system for classifying NIPCs following allogeneic HSCT. In addition, precise histopathological descriptions of the different NIPCs are currently not available to pathologists.…”