Pulmonary complications after T-cell-depleted allogeneic stem cell transplantation: low incidence and strong association with acute graft-versus-host disease

Abstract

Lung injury limits the success of allogeneic stem cell transplantation (SCT). The overall incidence varies from 30 to 50% and non-infectious causes occur in one-third to one-half of these. We reviewed pulmonary complications in 369 consecutive patients who received a partially T-celldepleted myeloablative allogeneic hematopoietic SCT at our institution between 1993 and 2003. All patients were treated uniformly with cyclophosphamide followed by total body irradiation. Control subjects were matched on sex, underlying diagnosis, age, type of transplantation and cytomegalovirus (CMV)-serostatus. Sixty-one patients (16.5%) developed pulmonary complications. Twentyone patients (5.7%) developed infectious pneumonia. Forty patients developed non-infectious complications which were further subclassified as bronchiolitis obliterans (3.5%), bronchiolitis obliterans-organizing pneumonia (0.5%), diffuse alveolar hemorrhage (0.8%), idiopathic pneumonia syndrome (5.5%) or mixed etiology (0.5%). Acute graft-versus-host disease (GVHD) Xgrade II was significantly more common in pulmonary patients than in the controls (36/61 versus 22/61 patients, P ¼ 0.02). There was no significant difference in the incidence of chronic GVHD (P ¼ 0.09). CMV reactivation was significantly more frequent in patients with lung injury (P ¼ 0.02). Median survival was 41 weeks for the pulmonary patients and 350 weeks for the controls (P ¼ 0.001). Altogether, the incidence of pulmonary complications is low after T-cell-depleted SCT and is associated with acute GVHD and CMV reactivation.

Gut Microbiota Predict Pulmonary Infiltrates after Allogeneic Hematopoietic Cell Transplantation

“…In a study of HCT recipients with bloodstream infections, postengraftment events were associated with worse outcomes, including death (62). "Late onset" noninfectious PCs, which may be subjected to diagnostic inaccuracy (63), have been associated with acute and chronic GVHD (35,64,65) and mortality (66). Many subjects in our study had multiple PCs, suggesting susceptibility to recurrent lung injury, incomplete resolution, and/or misdiagnosis and treatment of a previous PC.…”

Risk factors for fungal pulmonary infections in hematopoietic stem cell transplantation recipients: the role of iron overload

“…[8][9][10][11] Although most of the patients are reported to have multiple related risk factors, it is indicated that pulmonary complications do not develop in this entire high-risk group of patients that suggest that pathogenesis and the risk factors have not been completely understood yet. 5 The aim of this study was to evaluate the risk factors of FPIs due to HSCT.…”

Pre-transplant risk factors for cryptogenic organizing pneumonia/bronchiolitis obliterans organizing pneumonia after hematopoietic cell transplantation

“…Almost all of the previous studies were limited to case reports or series that did not include more than 10 cases of COP/BOOP, and/ or did not analyze COP/BOOP independently but rather as a part of late-onset non-infectious pulmonary complications. 6,7,[10][11][12][14][15][16][17] To the best of our knowledge, only one report, from Seattle, has included more than 20 cases (49 cases with COP/BOOP). 8 Thus, we performed a large retrospective study that included about 200 patients with COP/BOOP.…”