Document Detail

Prognostic factors for early severe pulmonary complications after hematopoietic stem cell transplantation.
MedLine Citation:
PMID:  11349809     Owner:  NLM     Status:  MEDLINE    
Pulmonary complications are a significant cause of early mortality (before day 100) after bone marrow transplantation (BMT). To identify factors associated with development of early post-BMT severe pulmonary complications (SPCs), we conducted a retrospective review of the medical records of 339 consecutive patients who underwent hematopoietic stem cell transplantation for hematologic disorders and identified pulmonary complications that occurred before day 60 posttransplantation. SPCs, defined as (1) diagnosis of diffuse alveolar hemorrhage, (2) need for mechanical ventilation, or (3) death from respiratory failure, occurred in 48 (24%) of 199 patients receiving allogeneic transplants and 4 (2.9%) of 140 patients receiving autologous transplants (P < .001). Multiple clinical variables were analyzed to determine their influence on the development of SPCs in allogeneic marrow recipients. The method of graft-versus-host disease (GVHD) prophylaxis was the single most important factor affecting SPC incidence. Of patients who received cyclosporine/methotrexate (CYA/MTX) as GVHD prophylaxis, 33% experienced SPCs compared with 8% of those receiving T-cell depletion (TCD) alone (P < .0001). Multivariate analysis confirmed that TCD was associated with a lower risk of SPCs (relative risk [RR], 0.18; P = .0006). In addition to GVHD prophylaxis, a reduced pretransplantation FEV1 (forced expiratory volume in 1 second) (< or = 80% of predicted) was associated with an increased risk for SPCs (odds ratio, 4.4; P = .0025). Grades 2 to 4 acute GVHD, tobacco use, age > or = 50 years, sex, unrelated donor, cytomegalovirus serologic status, disease status at transplantation, pretransplantation carbon monoxide diffusing capacity, and total body irradiation were not associated with development of SPCs. We conclude that autologous BMT is associated with a significantly lower incidence of SPCs compared with allogeneic BMT and that for allogeneic BMT, GVHD prophylaxis using TCD is associated with a significantly lower risk for SPCs compared with prophylaxis using CYA/MTX. Patients with pretransplantation FEV1 of < or = 80% appear to have a higher risk for SPCs.
V T Ho; E Weller; S J Lee; E P Alyea; J H Antin; R J Soiffer
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation     Volume:  7     ISSN:  1083-8791     ISO Abbreviation:  Biol. Blood Marrow Transplant.     Publication Date:  2001  
Date Detail:
Created Date:  2001-05-14     Completed Date:  2001-10-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9600628     Medline TA:  Biol Blood Marrow Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  223-9     Citation Subset:  IM    
Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
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MeSH Terms
Cytokines / physiology
Cytomegalovirus Infections / epidemiology
Growth Substances / physiology
Hematopoietic Stem Cell Transplantation / adverse effects*
Hemorrhage / epidemiology,  etiology
Immunosuppression / methods
Inflammation Mediators / physiology
Lung Diseases / epidemiology,  etiology*
Middle Aged
Odds Ratio
Radiation Injuries / epidemiology,  etiology
Respiration, Artificial / utilization
Respiratory Function Tests
Respiratory Insufficiency / epidemiology,  etiology
Retrospective Studies
Risk Factors
Smoking / epidemiology
Transplantation Conditioning / adverse effects*,  methods
Transplantation, Autologous
Transplantation, Homologous
Whole-Body Irradiation / adverse effects
Reg. No./Substance:
0/Cytokines; 0/Growth Substances; 0/Inflammation Mediators

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